MEDICARE: JESSICA MARY KANDEL

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	106S00000X	Behavior Technician	RBT-19-79873	IL

General Provider Information

NPI Number	:	1548728108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARY KANDEL

Provider Business Mailing Address
First Line	:	950 LEE ST STE 210
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-6574
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 LAKE COOK RD STE 314
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4933
Country	:	US
Telephone Number	:	877-486-4140
Fax Number	:

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

Provider Enumeration Date	:	03/03/2019
Last Update Date	:	03/03/2019

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