Healthcare Provider Details

I. General information

NPI: 1881422111
Provider Name (Legal Business Name): JOCELYN MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11560 S KEDZIE AVE STE 200
MERRIONETTE PARK IL
60803-4517
US

IV. Provider business mailing address

7829 S KEDVALE AVE
CHICAGO IL
60652-1228
US

V. Phone/Fax

Practice location:
  • Phone: 708-974-5800
  • Fax:
Mailing address:
  • Phone: 312-468-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: