Provider Demographics
NPI:1043046063
Name:JESSICA ROEDER LCSW PLLC
Entity type:Organization
Organization Name:JESSICA ROEDER LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-744-3024
Mailing Address - Street 1:2019 N SAWYER AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5170
Mailing Address - Country:US
Mailing Address - Phone:773-744-3024
Mailing Address - Fax:
Practice Address - Street 1:2019 N SAWYER AVE APT 2F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5170
Practice Address - Country:US
Practice Address - Phone:773-744-3024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)