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Individual

AMY JACOBSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
811 W EVERGREEN AVE STE 404, CHICAGO, IL 60642-7113
(312) 242-1665
Mailing address
10312 AUSTEN CT, MOKENA, IL 60448-7952
(708) 408-0412

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.013019
IL

Other

Enumeration date
04/10/2019
Last updated
04/10/2019
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