MEDICARE: JESSICA L. DAVIS LCSW

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
1	1041C0700X	Clinical Social Worker	149015950	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831539113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA L. DAVIS LCSW

Provider Business Mailing Address
First Line	:	803 E 41ST ST APT 1A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-2468
Country	:	US
Telephone Number	:	618-203-3113
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 E 41ST ST APT 1A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-2468
Country	:	US
Telephone Number	:	618-203-3113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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