Provider Demographics
NPI:1356315295
Name:SKROBOT, JACLYN MAE (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MAE
Last Name:SKROBOT
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PARK PL
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-6005
Mailing Address - Country:US
Mailing Address - Phone:815-937-1731
Mailing Address - Fax:
Practice Address - Street 1:110 MOONEY DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2171
Practice Address - Country:US
Practice Address - Phone:815-936-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0015802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer