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General NPI Number Information
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NPI Number | 1023794666
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Entity Type | Individual
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Provider Name | JAZMINE WOODALL
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Gender | Female
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 2923 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60618-7886
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Country | US
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Telephone | 800-206-8136
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Fax |
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Provider Business Mailing Address
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Address Line | 130 W 113TH PL
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City | CHICAGO
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State | IL
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Zip | 60628-4813
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Country | US
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Telephone | 773-387-2021
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Fax |
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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 |
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License Number State |
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