Healthcare Provider Details

I. General information

NPI: 1760314306
Provider Name (Legal Business Name): JAZZMINE L SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 N CENTER ST
NAPERVILLE IL
60563-3142
US

IV. Provider business mailing address

2454 GOLF RIDGE CIR
NAPERVILLE IL
60563-1503
US

V. Phone/Fax

Practice location:
  • Phone: 630-746-2625
  • Fax:
Mailing address:
  • Phone: 630-746-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.023274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: