Provider Demographics
NPI:1417134305
Name:HERRICK, JESICA ALLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESICA
Middle Name:ALLYN
Last Name:HERRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESICA
Other - Middle Name:ALLYN
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:808 S WOOD ST
Mailing Address - Street 2:MSC 735
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7300
Mailing Address - Country:US
Mailing Address - Phone:312-996-3418
Mailing Address - Fax:
Practice Address - Street 1:808 S WOOD ST
Practice Address - Street 2:MSC 735
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7300
Practice Address - Country:US
Practice Address - Phone:312-996-3418
Practice Address - Fax:312-413-1421
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.120746207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease