Provider Demographics
NPI:1609593102
Name:TRAUSCHT, JACLYN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ANN
Last Name:TRAUSCHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 N BISSELL ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5040
Mailing Address - Country:US
Mailing Address - Phone:847-602-7975
Mailing Address - Fax:
Practice Address - Street 1:1817 S LOOMIS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3018
Practice Address - Country:US
Practice Address - Phone:312-666-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant