| Urbanstreetz Therapy Llc | |
|
9204 S Commercial Ave Ste 206 Chicago IL 60617-2197 | |
| (773) 703-8486 | |
| (773) 530-7588 |
| Full Name | Urbanstreetz Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 9204 S Commercial Ave Ste 206, Chicago, Illinois |
| Authorized Official Name and Position | Jessica M Burnette (LCSW/OWNER) |
| Authorized Official Contact | 7737038486 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Urbanstreetz Therapy Llc 8364 S Kenwood Ave Chicago IL 60619-6437 Ph: (773) 703-8486 | Urbanstreetz Therapy Llc 9204 S Commercial Ave Ste 206 Chicago IL 60617-2197 Ph: (773) 703-8486 |
| NPI Number | 1023651049 |
|---|---|
| Provider Enumeration Date | 10/22/2019 |
| Last Update Date | 09/17/2022 |
| Certification Date | 09/17/2022 |
| Medicare PECOS PAC ID | 4981034600 |
|---|---|
| Medicare Enrollment ID | O20200421002167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023651049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jessica M Burnette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508393562 PECOS PAC ID: 3274965900 Enrollment ID: I20191118001639 |
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