Provider Demographics
NPI:1891125779
Name:LAUE, JILLIAN M (DPT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:M
Last Name:LAUE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:M
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:225 E DEERPATH STE 130
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1970
Practice Address - Country:US
Practice Address - Phone:847-482-1433
Practice Address - Fax:847-482-1483
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013122225100000X
NCP14456225100000X
IL070023390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist