Provider Demographics
NPI:1336375617
Name:REEDMAN, JESSICA LIL PORTER
Entity Type:Individual
Prefix:
First Name:JESSICA LIL
Middle Name:PORTER
Last Name:REEDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3837
Mailing Address - Country:US
Mailing Address - Phone:815-501-9832
Mailing Address - Fax:
Practice Address - Street 1:430 S 7TH ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3837
Practice Address - Country:US
Practice Address - Phone:815-501-9832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2250103171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator