Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070019243 | IL |
N | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1053667402 |
---|---|
Provider Name | Jessica Lejeune |
First Address | Chicago, IL 60657-9528 |
Second Address | Chicago, IL 60649-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2012 |
Last Update Date | 02/08/2012 |