Provider Demographics
NPI:1871936088
Name:LITMAN, JESSICA BOMBERG
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BOMBERG
Last Name:LITMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LEAH
Other - Last Name:BOMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1048 TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2755
Mailing Address - Country:US
Mailing Address - Phone:763-370-3931
Mailing Address - Fax:
Practice Address - Street 1:1048 TERRACE LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2755
Practice Address - Country:US
Practice Address - Phone:763-370-3931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2445490174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist