Provider Demographics
NPI:1346843836
Name:JEONG, ALICE YUNJIN (ATC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:YUNJIN
Last Name:JEONG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BEACONSFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-2905
Mailing Address - Country:US
Mailing Address - Phone:224-358-6226
Mailing Address - Fax:
Practice Address - Street 1:50 BEACONSFIELD CT
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-2905
Practice Address - Country:US
Practice Address - Phone:224-358-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0049822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer