Provider Demographics
NPI:1679946503
Name:TERRITO, JENNIFER (LPN, IBCLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TERRITO
Suffix:
Gender:F
Credentials:LPN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10496 LONGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-2363
Mailing Address - Country:US
Mailing Address - Phone:224-232-9171
Mailing Address - Fax:
Practice Address - Street 1:10496 LONGFIELD DR
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-2363
Practice Address - Country:US
Practice Address - Phone:224-232-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-44880174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN