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NPI Code Detail

MEDICARE: JESSICA SMITH

MEDICARE: JESSICA SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystBACB786156IL
2106S00000XBehavior TechnicianRBT-22-216144IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134866387
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SMITH
Provider Business Mailing Address
First Line : 1739 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60642-1544
Country : US
Telephone Number : 309-714-8330
Fax Number :
Provider Business Practice Location Address
First Line : 1233 W ADAMS ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-2801
Country : US
Telephone Number : 312-243-8487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2022
Last Update Date : 12/29/2025

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Directions to “ JESSICA SMITH ” Practice Location

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