Healthcare Provider Details

I. General information

NPI: 1295059772
Provider Name (Legal Business Name): JESSICA LYNN FOUCH B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W JEFFERSON ST
JOLIET IL
60435-6428
US

IV. Provider business mailing address

5901 W 87TH ST APT. 3E
OAK LAWN IL
60453-1393
US

V. Phone/Fax

Practice location:
  • Phone: 815-773-7119
  • Fax: 815-744-6916
Mailing address:
  • Phone: 815-773-7119
  • Fax: 815-744-6916

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: