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General NPI Number Information
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NPI Number | 1871309237
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Entity Type | Individual
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Provider Name | JESSICA EGUIA MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 2259 S DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60608-4232
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Country | US
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Telephone | 872-281-7575
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Fax |
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Provider Business Mailing Address
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Address Line | 4245 CUSTER AVE
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City | LYONS
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State | IL
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Zip | 60534-2916
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Country | US
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Telephone | 708-477-9268
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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 | 150.115426
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License Number State | IL
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