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General NPI Number Information
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NPI Number | 1003770223
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Entity Type | Individual
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Provider Name | JESSICA GEWONT
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Gender | Female
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 555 31ST ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1235
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Country | US
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Telephone | 630-971-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 7935 W 92ND ST APT 2E
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City | HICKORY HILLS
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State | IL
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Zip | 60457-8212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.011905
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License Number State | IL
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