Provider Demographics
NPI:1548829260
Name:RIOS, JESSICA I
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:I
Last Name:RIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3182
Mailing Address - Country:US
Mailing Address - Phone:224-800-2333
Mailing Address - Fax:
Practice Address - Street 1:1904 COUNTRY DR
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3182
Practice Address - Country:US
Practice Address - Phone:224-800-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician