MEDICARE: JESSICA JEANETTE HURTADO MSW, LCSW

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	1041C0700X	Clinical Social Worker	149.021940	IL

General Provider Information

NPI Number	:	1578103057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA JEANETTE HURTADO MSW, LCSW

Provider Business Mailing Address
First Line	:	2466 N LINDEN PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2625
Country	:	US
Telephone Number	:	773-453-8453
Fax Number	:

Provider Business Practice Location Address
First Line	:	3948 W 26TH ST STE 107
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3740
Country	:	US
Telephone Number	:	773-592-8263
Fax Number	:

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

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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