MEDICARE: JESSICA ANNE BOBLICK-URIBE LCSW, LICSW

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	LICSW128537	MA
2	1041C0700X	Clinical Social Worker	149018660	IL

General Provider Information

NPI Number	:	1679833453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANNE BOBLICK-URIBE LCSW, LICSW

Provider Business Mailing Address
First Line	:	2741 W WINNEMAC AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3675
Country	:	US
Telephone Number	:	708-548-5273
Fax Number	:	708-995-3803

Provider Business Practice Location Address
First Line	:	2741 W WINNEMAC AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3675
Country	:	US
Telephone Number	:	708-548-5273
Fax Number	:

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

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	03/27/2026

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