Individual
JESSICA MARIE GROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4031 W DAYTON ST, MCHENRY, IL 60050-8377
(815) 861-6219
Mailing address
4031 W DAYTON ST, MCHENRY, IL 60050-8377
(815) 861-6219
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.116205
IL
Other
Enumeration date
04/28/2016
Last updated
04/28/2016
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