Provider Demographics
NPI:1386100097
Name:KNOLL, JORDAN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:KNOLL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:VASQUEZ KNOLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2621 N AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60083-8904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17783 W BRAEWICK RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4597
Practice Address - Country:US
Practice Address - Phone:262-960-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer