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NPI Code Detail

MEDICARE: MOCHINIQUE JAMASON

MEDICARE: MOCHINIQUE JAMASON
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1780472928
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOCHINIQUE JAMASON
Provider Business Mailing Address
First Line : 13300 S BURLEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60633-1429
Country : US
Telephone Number : 773-968-0124
Fax Number :
Provider Business Practice Location Address
First Line : 4101 LIBERTY BLVD APT 1
Second Line :
City : WESTMONT
State : IL
Zip : 60559-1348
Country : US
Telephone Number : 630-426-9386
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2025
Last Update Date : 04/28/2025

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Directions to “ MOCHINIQUE JAMASON ” Practice Location

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