Healthcare Provider Details

I. General information

NPI: 1578103057
Provider Name (Legal Business Name): JESSICA JEANETTE HURTADO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3948 W 26TH ST STE 107
CHICAGO IL
60623-3740
US

IV. Provider business mailing address

2466 N LINDEN PL
CHICAGO IL
60647-2625
US

V. Phone/Fax

Practice location:
  • Phone: 773-592-8263
  • Fax:
Mailing address:
  • Phone: 773-453-8453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.021940
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: