Healthcare Provider Details

I. General information

NPI: 1194514786
Provider Name (Legal Business Name): JESSICA ESCUTIA CALDERON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 W LAWRENCE AVE
CHICAGO IL
60640-4702
US

IV. Provider business mailing address

1507 W LAWRENCE AVE
CHICAGO IL
60640-4702
US

V. Phone/Fax

Practice location:
  • Phone: 773-569-1468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.026413
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: