Healthcare Provider Details

I. General information

NPI: 1154451466
Provider Name (Legal Business Name): JESSICA LYNN BERKLAND L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LYNN BERKLAND L.M.T.

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SO. MAIN ST.
SENECA IL IL
61360
US

IV. Provider business mailing address

260 SO MAIN ST
SENECA IL
61360
US

V. Phone/Fax

Practice location:
  • Phone: 815-357-6858
  • Fax: 815-357-6857
Mailing address:
  • Phone: 815-357-6858
  • Fax: 815-357-6857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.001866
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: