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NPI Code Detail

MEDICARE: MR. KEVIN M. JESSE LCSW

MEDICARE:  MR. KEVIN M. JESSE  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
11041C0700XClinical Social Worker149008884IL

General Provider Information

NPI Number : 1700993193
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN M. JESSE LCSW
Provider Business Mailing Address
First Line : 9119 S EXCHANGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4225
Country : US
Telephone Number : 773-768-5000
Fax Number :
Provider Business Practice Location Address
First Line : 2501 W 103RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60655-1003
Country : US
Telephone Number : 773-445-0331
Fax Number : 773-779-2779
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 05/01/2020

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Directions to “ MR. KEVIN M. JESSE LCSW” Practice Location

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