Provider Demographics
NPI:1679066773
Name:HESS, JENNIFER (MS, ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HESS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DAILY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2506 LANTZ BUILDING
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920
Mailing Address - Country:US
Mailing Address - Phone:217-581-2215
Mailing Address - Fax:
Practice Address - Street 1:2506 LANTZ BUILDING
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920
Practice Address - Country:US
Practice Address - Phone:217-581-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960013032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer