Individual
JESSICA ROSE URBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12255 S 80TH AVE STE 204, PALOS HEIGHTS, IL 60463-1284
(708) 923-5900
(708) 923-8599
Mailing address
12255 S 80TH AVE STE 204, PALOS HEIGHTS, IL 60463-1284
(708) 923-5900
(708) 923-8599
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006946
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085006946
STATE LICENSE
IL
Enumeration date
02/13/2019
Last updated
07/17/2024
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