Individual
MRS. JACLYN REIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(312) 227-4000
Mailing address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(630) 415-8136
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209013232
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041390173
STATE LICENSE NUMBER
IL
Enumeration date
10/06/2015
Last updated
07/22/2025
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