Provider Demographics
NPI:1295059772
Name:FOUCH, JESSICA LYNN (BS)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNN
Last Name:FOUCH
Suffix:
Gender:F
Credentials:BS
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Other - Credentials:
Mailing Address - Street 1:5901 W 87TH ST
Mailing Address - Street 2:APT. 3E
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1393
Mailing Address - Country:US
Mailing Address - Phone:815-773-7119
Mailing Address - Fax:815-744-6916
Practice Address - Street 1:2401 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6428
Practice Address - Country:US
Practice Address - Phone:815-773-7119
Practice Address - Fax:815-744-6916
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst