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General NPI Number Information
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NPI Number | 1619747441
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Entity Type | Individual
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Provider Name | JESSICA ENGELKING
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Gender | Female
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 760 PASQUINELLI DR
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City | WESTMONT
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State | IL
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Zip | 60559-5564
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Country | US
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Telephone | 630-618-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 2031 W EVERGREEN AVE
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City | CHICAGO
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State | IL
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Zip | 60622-6957
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-23-67924
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License Number State | IL
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