Individual
DR. JACQUELINE GRACE REA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, ABPP-CN
Contact information
Practice address
10730 W 143RD ST STE 37, ORLAND PARK, IL 60462-1940
(800) 564-0863
Mailing address
10730 W 143RD ST STE 37, ORLAND PARK, IL 60462-1940
(800) 564-0863
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
071007463
IL
103TC2200X
Clinical Child & Adolescent Psychologist
071007463
IL
Other
Enumeration date
04/25/2008
Last updated
11/25/2014
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