Healthcare Provider Details

I. General information

NPI: 1427704063
Provider Name (Legal Business Name): MICHAEL J JESKE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DAVIS ST
EVANSTON IL
60201-3683
US

IV. Provider business mailing address

909 DAVIS ST
EVANSTON IL
60201-3683
US

V. Phone/Fax

Practice location:
  • Phone: 847-425-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149025631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: