Provider Demographics
NPI:1174725139
Name:KOMBRINK, JILL M
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:M
Last Name:KOMBRINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40W355 WILLIAM CULLEN BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6562
Mailing Address - Country:US
Mailing Address - Phone:630-377-2505
Mailing Address - Fax:630-444-7321
Practice Address - Street 1:40W355 WILLIAM CULLEN BRYANT ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6562
Practice Address - Country:US
Practice Address - Phone:630-377-2505
Practice Address - Fax:630-444-7321
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist