Basic Information
| Provider Information | |||||||||
| NPI: | 1295060226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3330 W 177TH ST STE 1F | ||||||||
| Address2: | |||||||||
| City: | HAZEL CREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604292186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087453040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3330 W 177TH ST STE 1F | ||||||||
| Address2: | |||||||||
| City: | HAZEL CREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604292186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087453040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2009 | ||||||||
| LastUpdateDate: | 03/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149.012950 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.