Healthcare Provider Details

I. General information

NPI: 1972326932
Provider Name (Legal Business Name): JACQUELINE MARKIS LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W JACKSON BLVD STE 1700
CHICAGO IL
60604-3597
US

IV. Provider business mailing address

111 W JACKSON BLVD STE 1700
CHICAGO IL
60604-3597
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 646-941-7645
  • Fax: 929-596-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.031511
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: