Provider Demographics
NPI:1417570920
Name:JESSICA WHELAN LLC
Entity Type:Organization
Organization Name:JESSICA WHELAN LLC
Other - Org Name:HOLON INCLUSIVE HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA,FPMHNP-BC, RN-BC
Authorized Official - Phone:314-470-1220
Mailing Address - Street 1:16549 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1720
Mailing Address - Country:US
Mailing Address - Phone:636-236-5128
Mailing Address - Fax:
Practice Address - Street 1:301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DUPO
Practice Address - State:IL
Practice Address - Zip Code:62239-1325
Practice Address - Country:US
Practice Address - Phone:314-470-1220
Practice Address - Fax:833-914-0432
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLON INCLUSIVE HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-19
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILSTL70408459OtherQUEST ACCOUNT
IL91674OtherMCKESSON SUBMITTER
IL691674OtherMCKESSON SUBMITTER
IL1760018774OtherNPI