Healthcare Provider Details

I. General information

NPI: 1801758362
Provider Name (Legal Business Name): JASMINE REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N LINCOLN AVE
ADDISON IL
60101-2506
US

IV. Provider business mailing address

701 N LINCOLN AVE
ADDISON IL
60101-2506
US

V. Phone/Fax

Practice location:
  • Phone: 331-262-3194
  • Fax: 331-262-3194
Mailing address:
  • Phone: 331-262-3194
  • Fax: 331-262-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: