Healthcare Provider Details

I. General information

NPI: 1003770223
Provider Name (Legal Business Name): JESSICA GEWONT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 31ST ST
DOWNERS GROVE IL
60515-1235
US

IV. Provider business mailing address

7935 W 92ND ST APT 2E
HICKORY HILLS IL
60457-8212
US

V. Phone/Fax

Practice location:
  • Phone: 630-971-6080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.011905
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: