Healthcare Provider Details

I. General information

NPI: 1861040248
Provider Name (Legal Business Name): JESSICA JAEGER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 550
PARK RIDGE IL
60068-1188
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-384-1420
  • Fax: 847-318-9332
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-007033
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: