Healthcare Provider Details

I. General information

NPI: 1619889409
Provider Name (Legal Business Name): TESSEL JICKU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 N WESTGATE RD
MOUNT PROSPECT IL
60056-2673
US

IV. Provider business mailing address

290 N WESTGATE RD
MOUNT PROSPECT IL
60056-2673
US

V. Phone/Fax

Practice location:
  • Phone: 224-370-9509
  • Fax:
Mailing address:
  • Phone: 224-370-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.039957
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: