Provider Demographics
NPI:1053473371
Name:GOTTSCHALL, JESSIE ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:ANNE
Last Name:GOTTSCHALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 BLUFF CT
Mailing Address - Street 2:UNIT A
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7355
Mailing Address - Country:US
Mailing Address - Phone:847-713-2395
Mailing Address - Fax:847-713-2395
Practice Address - Street 1:5206 W ELM ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4000
Practice Address - Country:US
Practice Address - Phone:815-363-7001
Practice Address - Fax:847-713-2395
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7296123104100000X
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker