Provider Demographics
NPI:1902570658
Name:ATASSI, JESSICA ANNE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:ATASSI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1742 N CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4706
Mailing Address - Country:US
Mailing Address - Phone:312-415-2688
Mailing Address - Fax:
Practice Address - Street 1:1772 MELBOURNE LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60503-7601
Practice Address - Country:US
Practice Address - Phone:630-410-9587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150103509104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker