Provider Demographics
NPI:1033972120
Name:ESTRADA, JACQUELINE EILEEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:EILEEN
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6058 S TRIPP AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4925
Mailing Address - Country:US
Mailing Address - Phone:773-993-4238
Mailing Address - Fax:
Practice Address - Street 1:6058 S TRIPP AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4925
Practice Address - Country:US
Practice Address - Phone:773-993-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017419101YM0800X
IL2417811103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health