MEDICARE: MS. JESSICA LYNN FOUCH B.S.

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1295059772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA LYNN FOUCH B.S.

Provider Business Mailing Address
First Line	:	5901 W 87TH ST
Second Line	:	APT. 3E
City	:	OAK LAWN
State	:	IL
Zip	:	60453-1393
Country	:	US
Telephone Number	:	815-773-7119
Fax Number	:	815-744-6916

Provider Business Practice Location Address
First Line	:	2401 W JEFFERSON ST
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-6428
Country	:	US
Telephone Number	:	815-773-7119
Fax Number	:	815-744-6916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2010
Last Update Date	:	03/26/2010

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