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General NPI Number Information
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NPI Number | 1134496045
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Entity Type | Individual
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Provider Name | JESSICA VICTORIA HAACK L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2011
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1443
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Country | US
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Telephone | 773-795-5704
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Fax |
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Provider Business Mailing Address
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Address Line | 1839 W IRVING PARK RD APT 4R
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City | CHICAGO
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State | IL
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Zip | 60613-2497
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Country | US
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Telephone | 847-308-5668
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.015290
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License Number State | IL
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