Provider Demographics
NPI:1164048195
Name:PERRIN, JAYVA LONYAE
Entity Type:Individual
Prefix:MS
First Name:JAYVA
Middle Name:LONYAE
Last Name:PERRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 W GALENA BLVD STE 8-316
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-3255
Mailing Address - Country:US
Mailing Address - Phone:708-965-2268
Mailing Address - Fax:
Practice Address - Street 1:2112 W GALENA BLVD STE 8-316
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-3255
Practice Address - Country:US
Practice Address - Phone:708-965-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist