Basic Information
| Provider Information | |||||||||
| NPI: | 1811463664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMPTON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | N | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SIMPSON | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | N | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15127 S 73RD AVE STE G | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604623425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003616880 | ||||||||
| FaxNumber: | 7088455505 | ||||||||
| Practice Location | |||||||||
| Address1: | 16107 LA SALLE ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH HOLLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604732064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003616880 | ||||||||
| FaxNumber: | 7088455505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2018 | ||||||||
| LastUpdateDate: | 10/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149.020323 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.