Provider Demographics
NPI:1750067120
Name:KICK, JESSICA ERIN (MED)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:KICK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ERIN
Other - Last Name:HORVATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4342 N KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2112
Mailing Address - Country:US
Mailing Address - Phone:312-401-1768
Mailing Address - Fax:
Practice Address - Street 1:4342 N KEELER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2112
Practice Address - Country:US
Practice Address - Phone:312-401-1768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist