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General NPI Number Information
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NPI Number | 1730957176
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Entity Type | Individual
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Provider Name | QUIANA MICHELLE JEFFERSON
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Gender | Female
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 579 W NORTH AVE STE 206
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City | ELMHURST
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State | IL
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Zip | 60126-2144
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Country | US
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Telephone | 630-384-9499
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Fax | 630-324-4606
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Provider Business Mailing Address
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Address Line | 123 PARK ST
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City | OSWEGO
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State | IL
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Zip | 60543-9079
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Country | US
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Telephone | 773-653-7890
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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 | 150110997
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License Number State | IL
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