MICHELLE LEEANN JACOB Athletic Trainer License verification

Business Entity

NOT RENEWED

License Type

Athletic Trainer

Description

LICENSED ATHLETIC TRAINER

License Number

096001655

License Status

NOT RENEWED

Business

First Name

MICHELLE

Middle

LEEANN

Last Name

JACOB

Business Name

MICHELLE LEEANN JACOB

Original Issue Date

06/17/2002

Effective Date

04/07/2004

Expiration Date

05/31/2006

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Ever Disciplined

LastModifiedDate

07/17/2006