Provider Demographics
NPI:1619346012
Name:WOEHRMYER, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WOEHRMYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W LAKE ST
Mailing Address - Street 2:2L
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1710
Mailing Address - Country:US
Mailing Address - Phone:269-506-3044
Mailing Address - Fax:
Practice Address - Street 1:910 W LAKE ST
Practice Address - Street 2:2L
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1710
Practice Address - Country:US
Practice Address - Phone:269-506-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0039992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer