Healthcare Provider Details

I. General information

NPI: 1942067608
Provider Name (Legal Business Name): JESSICA OBREMSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 N EOLA RD STE A
AURORA IL
60502-9110
US

IV. Provider business mailing address

5 WHEATON CTR APT 309
WHEATON IL
60187-4997
US

V. Phone/Fax

Practice location:
  • Phone: 630-569-4932
  • Fax:
Mailing address:
  • Phone: 630-999-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: