Healthcare Provider Details

I. General information

NPI: 1437067022
Provider Name (Legal Business Name): JESSICA LUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W WILLOW AVE FL 2
WHEATON IL
60187-5275
US

IV. Provider business mailing address

127 W WILLOW AVE FL 2
WHEATON IL
60187-5275
US

V. Phone/Fax

Practice location:
  • Phone: 331-806-3686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: