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NPI Code Detail

MEDICARE: MS. JESSICA PENDERGAST LSW

MEDICARE: MS. JESSICA PENDERGAST LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker150.105509IL

General Provider Information

NPI Number : 1669127601
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA PENDERGAST LSW
Provider Business Mailing Address
First Line : 4326 NUTMEG LN APT 117
Second Line :
City : LISLE
State : IL
Zip : 60532-1799
Country : US
Telephone Number : 312-505-1056
Fax Number :
Provider Business Practice Location Address
First Line : 777 W ARMY TRAIL BLVD FL 2
Second Line :
City : ADDISON
State : IL
Zip : 60101-3163
Country : US
Telephone Number : 630-693-7934
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2022
Last Update Date : 02/17/2022

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