MEDICARE: JASMINE BAGGETT

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	150107185	IL
2	1041C0700X	Clinical Social Worker	149.025929	IL

General Provider Information

NPI Number	:	1780342311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE BAGGETT

Provider Business Mailing Address
First Line	:	6920 W 65TH ST APT 8
Second Line	:
City	:	BEDFORD PARK
State	:	IL
Zip	:	60638-4675
Country	:	US
Telephone Number	:	773-621-8135
Fax Number	:

Provider Business Practice Location Address
First Line	:	20015 S LAGRANGE RD
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3104
Country	:	US
Telephone Number	:	773-340-9622
Fax Number	:

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

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	10/02/2024

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Directions to “ JASMINE BAGGETT ” Practice Location

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