Healthcare Provider Details

I. General information

NPI: 1801476072
Provider Name (Legal Business Name): JESSICA BEAUDRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 COMPASS RD
GLENVIEW IL
60026-8001
US

IV. Provider business mailing address

4323 HARRISON ST APT 90
BATESVILLE AR
72501-8454
US

V. Phone/Fax

Practice location:
  • Phone: 877-787-3430
  • Fax:
Mailing address:
  • Phone: 501-827-5301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: