Individual
JENNIFER GRAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1740 W TAYLOR ST, CHICAGO, IL 60612-7232
(866) 600-2273
Mailing address
1853 W POLK ST, CHICAGO, IL 60612-4355
(312) 996-2450
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/03/2019
Last updated
05/03/2019
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