Healthcare Provider Details

I. General information

NPI: 1003969189
Provider Name (Legal Business Name): JENNIFER HEGGATON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5192
US

IV. Provider business mailing address

1534 HERBERT ST
DOWNERS GROVE IL
60515-1851
US

V. Phone/Fax

Practice location:
  • Phone: 630-681-4502
  • Fax:
Mailing address:
  • Phone: 630-347-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.002300
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: