Provider Demographics
NPI:1629386677
Name:REICH, JESSICA LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:REICH
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 1:9000 WAUKEGAN RD
Mailing Address - Street 2:210
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2127
Mailing Address - Country:US
Mailing Address - Phone:847-967-5122
Mailing Address - Fax:847-967-5125
Practice Address - Street 1:9000 WAUKEGAN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2127
Practice Address - Country:US
Practice Address - Phone:847-967-5122
Practice Address - Fax:847-967-5125
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant