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NPI Code Detail

MEDICARE: JACQUELINE BAUTISTA

MEDICARE: JACQUELINE BAUTISTA
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
1104100000XSocial Worker1501147IL

General Provider Information

NPI Number : 1831948900
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE BAUTISTA
Provider Business Mailing Address
First Line : 414 PLAZA DR STE 301
Second Line :
City : WESTMONT
State : IL
Zip : 60559-5508
Country : US
Telephone Number : 630-728-1744
Fax Number :
Provider Business Practice Location Address
First Line : 414 PLAZA DR STE 301
Second Line :
City : WESTMONT
State : IL
Zip : 60559-5508
Country : US
Telephone Number : 630-728-1744
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2024
Last Update Date : 04/15/2026

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Directions to “ JACQUELINE BAUTISTA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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