Healthcare Provider Details

I. General information

NPI: 1942420567
Provider Name (Legal Business Name): ABIGAIL DIANE WACASER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S WEBSTER AVE
JACKSONVILLE IL
62650-1877
US

IV. Provider business mailing address

325 E SPRUCE ST
CHATHAM IL
62629-1624
US

V. Phone/Fax

Practice location:
  • Phone: 217-479-4284
  • Fax: 217-479-4326
Mailing address:
  • Phone: 217-370-6103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2144651
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: