Provider Demographics
NPI:1871309237
Name:EGUIA, JESSICA (MSW, LSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EGUIA
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-2916
Mailing Address - Country:US
Mailing Address - Phone:708-477-9268
Mailing Address - Fax:
Practice Address - Street 1:2259 S DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4232
Practice Address - Country:US
Practice Address - Phone:872-281-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.115426104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker