Healthcare Provider Details

I. General information

NPI: 1245170265
Provider Name (Legal Business Name): JESSICA ROSE ERIKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16086 HARLEM AVE
TINLEY PARK IL
60477-1612
US

IV. Provider business mailing address

11628 ROBERTS ST APT 5
MOKENA IL
60448-1228
US

V. Phone/Fax

Practice location:
  • Phone: 708-505-8177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: