Provider Demographics
NPI:1043515307
Name:JACQUES, DANIELLE JEAN
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JEAN
Last Name:JACQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:JEAN
Other - Last Name:JACQUES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1012 TEAL RD
Mailing Address - Street 2:
Mailing Address - City:PEOTONE
Mailing Address - State:IL
Mailing Address - Zip Code:60468
Mailing Address - Country:US
Mailing Address - Phone:815-401-2938
Mailing Address - Fax:
Practice Address - Street 1:1012 TEAL RD
Practice Address - Street 2:
Practice Address - City:PEOTONE
Practice Address - State:IL
Practice Address - Zip Code:60468-8984
Practice Address - Country:US
Practice Address - Phone:815-401-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist