Healthcare Provider Details

I. General information

NPI: 1922582758
Provider Name (Legal Business Name): JESSICA HEUER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N MARSHFIELD AVE
CHICAGO IL
60622-6731
US

IV. Provider business mailing address

1618 W CHICAGO AVE APT 2
CHICAGO IL
60622-8059
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-6097
  • Fax:
Mailing address:
  • Phone:
  • 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: