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NPI Code Detail

MEDICARE: JESSICA GWILLIAM LCSW

MEDICARE: JESSICA GWILLIAM 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 Worker149.022985IL

General Provider Information

NPI Number : 1922679976
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA GWILLIAM LCSW
Provider Business Mailing Address
First Line : 4433 N RAVENSWOOD AVE STE 210
Second Line :
City : CHICAGO
State : IL
Zip : 60640-7755
Country : US
Telephone Number : 773-876-8763
Fax Number : 872-315-3138
Provider Business Practice Location Address
First Line : 4433 N RAVENSWOOD AVE STE 210
Second Line :
City : CHICAGO
State : IL
Zip : 60640-7755
Country : US
Telephone Number : 773-876-8763
Fax Number : 872-315-3138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2021
Last Update Date : 07/09/2021

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