Anderson, Jackie Lou

Anderson, Jackie Lou is an sole proprietor health care provider with primary practice located at 101 Shoreland Rd , Machesney Park IL 61115-2833. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist, which is considered as her primary health care specialty. Anderson, Jackie Lou can be contacted via phone (815) 633-1173.

Contact Information

Primary practice address
101 Shoreland Rd Machesney Park IL 61115-2833
Phone: (815) 633-1173
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist 222Q00000X Illinois

Profile Details

NPI number 1295004406
LBN Legal business name Anderson, Jackie Lou
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 16th, 2011
Last updated Dec 16th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295004406 NPPES
Illinois Other 222Q00000X EI

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