Healthcare Provider Details

I. General information

NPI: 1922937754
Provider Name (Legal Business Name): JESSICA EBITU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7234 W NORTH AVE SUITE 208
CHICAGO IL
60707-1234
US

IV. Provider business mailing address

7234 W NORTH AVE SUITE 208
CHICAGO IL
60707-1234
US

V. Phone/Fax

Practice location:
  • Phone: 202-891-1725
  • Fax:
Mailing address:
  • Phone: 202-891-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: