Provider Demographics
NPI:1831473693
Name:WRIGHT, JONATHAN L (BC-HIS, ACA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:BC-HIS, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14316 S WILL COOK RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9211
Mailing Address - Country:US
Mailing Address - Phone:708-966-4724
Mailing Address - Fax:708-949-8015
Practice Address - Street 1:14316 S WILL COOK RD
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9211
Practice Address - Country:US
Practice Address - Phone:708-966-4724
Practice Address - Fax:708-949-8015
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist