Provider Demographics
NPI:1740596543
Name:TUCKER, JEAN M (CNS, MS)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CNS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 E SCHAUMBURG RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-5166
Mailing Address - Country:US
Mailing Address - Phone:847-895-4540
Mailing Address - Fax:847-895-4544
Practice Address - Street 1:1375 E SCHAUMBURG RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-5166
Practice Address - Country:US
Practice Address - Phone:847-895-4540
Practice Address - Fax:847-895-4544
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008253364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-008253OtherLICENSE ADVANCE PRACTICE NURSE