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NPI Code Detail

MEDICARE: JESSICA ELLIS MA

MEDICARE: JESSICA ELLIS MA
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1417764044
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ELLIS MA
Provider Business Mailing Address
First Line : 30 N MICHIGAN AVE STE 925
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3463
Country : US
Telephone Number : 312-263-9400
Fax Number : 312-263-9401
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE STE 925
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3463
Country : US
Telephone Number : 312-263-9400
Fax Number : 312-263-9401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2024
Last Update Date : 12/17/2024

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Directions to “ JESSICA ELLIS MA” Practice Location

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