Individual
JACLYN L MIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
17495 LA GRANGE RD, TINLEY PARK, IL 60487-7581
(815) 416-6641
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
(708) 388-5672
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004190
IL
Other
Enumeration date
10/28/2011
Last updated
07/24/2023
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