Healthcare Provider Details

I. General information

NPI: 1922919406
Provider Name (Legal Business Name): JESSICA L LIVINGSTON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 INGLESIDE AVE
AURORA IL
60506-4808
US

IV. Provider business mailing address

160 INGLESIDE AVE
AURORA IL
60506-4808
US

V. Phone/Fax

Practice location:
  • Phone: 630-674-3129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.028068
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: