Active NPI
Jazmin Quintanilla-Rendon
- Clinical Social Worker
- Great Lakes, IL
National Provider Identifier
1891687182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 121704
- Practice address
- 2410 Sampson St
Great Lakes, IL 60088-2942 - Phone
- (847) 688-2469
- NPI assigned
- Jul 19, 2025
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 121704 | CA | Primary |
Addresses
Primary practice location
2410 Sampson St
Great Lakes, IL 60088-2942
Mailing address
12772 71St St Apt 319
Kenosha, WI 53142-8431
Phone (619) 712-7944
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 121704 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752883200000",
"number": "1891687182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12772 71ST ST APT 319",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531428431",
"telephone_number": "619-712-7944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2410 SAMPSON ST",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600882942",
"telephone_number": "847-688-2469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUINTANILLA-RENDON",
"first_name": "JAZMIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-07-19",
"last_updated": "2025-07-19",
"certification_date": "2025-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "121704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Lakes, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.