Jacquelyn Banks, | |
12757 Western Ave, Blue Island, IL 60406-2155 | |
(708) 293-8400 | |
Not Available |
Full Name | Jacquelyn Banks |
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Gender | Female |
Speciality | Social Worker - Clinical |
Location | 12757 Western Ave, Blue Island, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1972225738 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | 149.024025 (Illinois) | Primary |
Entity Name | Cook County |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1588612832 PECOS PAC ID: 2860398088 Enrollment ID: O20031209000747 |
Mailing Address | Practice Location Address |
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Jacquelyn Banks, Po Box 170198, Chicago, IL 60617-9198 Ph: () - | Jacquelyn Banks, 12757 Western Ave, Blue Island, IL 60406-2155 Ph: (708) 293-8400 |
Ms. Juliet Ann Russom Walden, BS, AM, LSCW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 13136 Western Ave, Blue Island, IL 60406 Phone: 708-974-5800 | |
Amanda Keenan, LCSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 3046 127th St, Blue Island, IL 60406 Phone: 708-377-7920 Fax: 708-930-0414 | |
Kristen Hofman, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 13136 Western Ave, Blue Island, IL 60406 Phone: 708-974-5800 | |
Jessica Null, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 12331 Gregory St, Blue Island, IL 60406 Phone: 708-489-7338 | |
Mr. George Fay Henry Jr., LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 12311 Meadow Ln, Unit 1b, Blue Island, IL 60406 Phone: 312-504-5560 | |
Candace Clark, Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 13136 Western Ave, Blue Island, IL 60406 Phone: 708-974-5864 | |
Meghan Kelly, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 13136 Western Ave, Blue Island, IL 60406 Phone: 708-974-5800 Fax: 708-974-2498 |