Individual
JENSEN PLATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, ATC
Contact information
Practice address
14265 W SHELLEY LN, WADSWORTH, IL 60083-9550
(847) 989-2377
Mailing address
14265 W SHELLEY LN, WADSWORTH, IL 60083-9550
(847) 989-2377
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2000035573
IL
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/08/2018
Last updated
05/23/2019
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