Healthcare Provider Details

I. General information

NPI: 1932033586
Provider Name (Legal Business Name): JEMMA ANN JOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 564
NORTHBROOK IL
60065-0564
US

IV. Provider business mailing address

601 W HUNTINGTON COMMONS RD APT 101
MOUNT PROSPECT IL
60056-5249
US

V. Phone/Fax

Practice location:
  • Phone: 847-604-0955
  • Fax:
Mailing address:
  • Phone: 224-659-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number81-5021069
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: