Provider Demographics
NPI:1275044984
Name:JASSO, ANNETTE M
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:JASSO
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 1:20981 W STATE ROUTE 102
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-8957
Mailing Address - Country:US
Mailing Address - Phone:630-816-4051
Mailing Address - Fax:
Practice Address - Street 1:20981 W STATE ROUTE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-8957
Practice Address - Country:US
Practice Address - Phone:630-816-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist