Healthcare Provider Details

I. General information

NPI: 1952014961
Provider Name (Legal Business Name): JESSICA MOLINAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 W EXECUTIVE DR STE 500
ADDISON IL
60101-5626
US

IV. Provider business mailing address

2171 W EXECUTIVE DR STE 500
ADDISON IL
60101-5626
US

V. Phone/Fax

Practice location:
  • Phone: 630-766-0505
  • Fax:
Mailing address:
  • Phone: 630-766-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.008158
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: