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General NPI Number Information
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NPI Number | 1629261391
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Entity Type | Individual
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Provider Name | JACQUELINE MARIE SHELTON-ESPINOSA L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 400 W LAKE ST SUITE 208
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City | ROSELLE
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State | IL
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Zip | 60172-3574
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Country | US
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Telephone | 630-464-8890
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Fax | 630-529-1113
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Provider Business Mailing Address
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Address Line | 1000 BAYSIDE DR UNIT 104
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City | PALATINE
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State | IL
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Zip | 60074-2299
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Country | US
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Telephone | 630-464-8890
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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 | 149.012728
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License Number State | IL
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