Healthcare Provider Details

I. General information

NPI: 1528615366
Provider Name (Legal Business Name): JACQUELINE MACHAMER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 04/21/2023
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 W SHAMROCK LN UNIT C
MCHENRY IL
60050-8700
US

IV. Provider business mailing address

4209 W SHAMROCK LN UNIT C
MCHENRY IL
60050-8700
US

V. Phone/Fax

Practice location:
  • Phone: 224-595-0835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.024753
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: