Hansen, Jessie
Hansen, Jessie is an individual health care provider with primary practice located at 541 Spruce Rd , Bolingbrook IL 60440-2504. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Hansen, Jessie can be contacted via phone (630) 880-6523.Contact Information
Primary practice address
541 Spruce Rd
Bolingbrook IL 60440-2504
Phone: (630) 880-6523
Fax: (630) 929-8057
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 14D2099042 | Illinois |
Profile Details
| NPI number | 1992179972 |
|---|---|
| LBN Legal business name | Hansen, Jessie |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 13th, 2015 |
| Last updated | Nov 13th, 2015 - about 11 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992179972 | NPPES |
| Illinois | Other | 14D2099042 | CERTIFICATE OF WAIVER CLIA |
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