Healthcare Provider Details

I. General information

NPI: 1275215345
Provider Name (Legal Business Name): JEP THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S LINCOLNWAY
NORTH AURORA IL
60542-1663
US

IV. Provider business mailing address

2782 CRANSTON CIR
YORKVILLE IL
60560-4613
US

V. Phone/Fax

Practice location:
  • Phone: 630-801-1669
  • Fax:
Mailing address:
  • Phone: 630-437-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JARED ELWART
Title or Position: MANAGER
Credential: LCSW
Phone: 630-437-1199