Provider Demographics
NPI:1780472928
Name:JAMASON, MOCHINIQUE
Entity type:Individual
Prefix:
First Name:MOCHINIQUE
Middle Name:
Last Name:JAMASON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13300 S BURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60633-1429
Mailing Address - Country:US
Mailing Address - Phone:773-968-0124
Mailing Address - Fax:
Practice Address - Street 1:4101 LIBERTY BLVD APT 1
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1348
Practice Address - Country:US
Practice Address - Phone:630-426-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist