Healthcare Provider Details

I. General information

NPI: 1144133042
Provider Name (Legal Business Name): JESSICA ERVING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 N PINE GROVE AVE
CHICAGO IL
60614-6109
US

IV. Provider business mailing address

706 E IVY LN
ARLINGTON HEIGHTS IL
60004-3230
US

V. Phone/Fax

Practice location:
  • Phone: 312-259-2665
  • Fax:
Mailing address:
  • Phone: 847-636-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149021808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: