Jessica Jacknow

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160003547 Issued in IL

Practice address

140 Lathrop Ave
Forest Park, IL 60130-1067

Phone

(773) 209-5377

NPI assigned

Jul 29, 2016

Last updated

Jul 29, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Avante Therapy Services

  • Physical Therapy Assistant
  • Forest Park, IL
  • NPI 1861945529
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469750400000",
    "number": "1013460781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 LATHROP AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601301067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 LATHROP AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601301067",
            "telephone_number": "773-209-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKNOW",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-29",
        "last_updated": "2016-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160003547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maureen Hurley
• Huma Hussain, OD
• Illinois Behavior Analysis Group, LLC
• Illinois Dental Providers (Harlem & North), LTD. (DentalWorks of Forest Park)
• Isa's Creative Counseling
• Marvin Zebedee Jackson Jr., B.S.,D.C.
• Karen Janiec, NP
• Jayreese Transportation Service
• Debra L Jensen, L. AC.
• Jerry E Udelson, DDS, PC (Little Teeth Big Smiles & Children's Dentistry)

• Physical Therapy Assistant in Forest Park, IL
• Providers in Forest Park, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.