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General NPI Number Information
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NPI Number | 1003169780
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Entity Type | Individual
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Provider Name | JENNIFER M VERGARA MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 4722 ARBOR DR APT 207
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City | ROLLING MEADOWS
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State | IL
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Zip | 60008-4426
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Country | US
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Telephone | 312-388-5394
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Fax |
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Provider Business Mailing Address
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Address Line | 110 S HAGER AVE
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City | BARRINGTON
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State | IL
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Zip | 60010-4168
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Country | US
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Telephone | 847-381-0345
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Fax | 847-381-9297
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150013629
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License Number State | IL
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