Provider Demographics
NPI:1821357302
Name:JAJICH, MICHELLE CHRISTEN (DT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTEN
Last Name:JAJICH
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 HUNTINGTON CT
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090
Mailing Address - Country:US
Mailing Address - Phone:630-947-9055
Mailing Address - Fax:
Practice Address - Street 1:1717 HUNTINGTON CT
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-6903
Practice Address - Country:US
Practice Address - Phone:630-947-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist