Individual
JESSICA A MORTILLARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
7400 AUGUSTA ST, RIVER FOREST, IL 60305-1402
(708) 209-3620
Mailing address
1511 OAKTON ST, EVANSTON, IL 60202-2722
(847) 721-1351
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.004296
IL
Other
Enumeration date
04/05/2019
Last updated
04/05/2019
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