Provider Demographics
NPI:1174664445
Name:WRIGHT, JENNIFER (BS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 DAVIS ST
Mailing Address - Street 2:STE 220
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:909 DAVIS ST
Practice Address - Street 2:STE 220
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3645
Practice Address - Country:US
Practice Address - Phone:847-733-7906
Practice Address - Fax:847-733-8405
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160003962225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant