Provider Demographics
NPI:1154451466
Name:BERKLAND, JESSICA LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:BERKLAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:BERKLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:260 SO MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:IL
Mailing Address - Zip Code:61360
Mailing Address - Country:US
Mailing Address - Phone:815-357-6858
Mailing Address - Fax:815-357-6857
Practice Address - Street 1:260 SO. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SENECA IL
Practice Address - State:IL
Practice Address - Zip Code:61360
Practice Address - Country:US
Practice Address - Phone:815-357-6858
Practice Address - Fax:815-357-6857
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.001866225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist