MEDICARE: JACQUELINE HEEMSTRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1154107472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE HEEMSTRA

Provider Business Mailing Address
First Line	:	1 E NORTHWEST HWY STE 201
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-1700
Country	:	US
Telephone Number	:	847-908-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 E NORTHWEST HWY STE 201
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-1700
Country	:	US
Telephone Number	:	847-908-8700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2023
Last Update Date	:	06/18/2026

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