Provider Demographics
NPI:1407288244
Name:LEPAGE, JESSICA ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:LEPAGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:WALDECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:50 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5485
Mailing Address - Country:US
Mailing Address - Phone:469-515-0865
Mailing Address - Fax:
Practice Address - Street 1:50 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5485
Practice Address - Country:US
Practice Address - Phone:469-515-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1232320225100000X
IL070.024936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist