Active NPI
Jillian Renee Carpenter
- Developmental Therapist
- Benton, IL
National Provider Identifier
1154680437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 401 W 6TH St
Benton, IL 62812-1247 - Phone
- (815) 600-3078
- NPI assigned
- May 8, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | IL | Primary |
Addresses
Primary practice location
401 W 6TH St
Benton, IL 62812-1247
Mailing address
401 W 6TH St
Benton, IL 62812-1247
Phone (815) 600-3078
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336435200000",
"number": "1154680437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 W 6TH ST",
"city": "BENTON",
"state": "IL",
"postal_code": "628121247",
"telephone_number": "815-600-3078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 W 6TH ST",
"city": "BENTON",
"state": "IL",
"postal_code": "628121247",
"telephone_number": "815-600-3078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARPENTER",
"first_name": "JILLIAN",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-08",
"last_updated": "2012-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.