Individual
JESSICA REVORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8296
Mailing address
3010 GRAND AVE, WAUKEGAN, IL 60085-2321
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
338784
IL
101YP2500X
Professional Counselor
Primary
178.010397
IL
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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