Healthcare Provider Details

I. General information

NPI: 1336078104
Provider Name (Legal Business Name): JAEDYN GIANNA GRIFFITH CARRICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N COUNTY FARM RD
WHEATON IL
60187-3977
US

IV. Provider business mailing address

67 KINGSPORT DR
SOUTH ELGIN IL
60177-2900
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-7400
  • Fax:
Mailing address:
  • Phone: 224-503-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: