Provider Demographics
NPI:1235215690
Name:HUNTER-EGGMAN, JEFFRY (LCSW)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:
Last Name:HUNTER-EGGMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 W 183RD ST
Mailing Address - Street 2:SUITE NE
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9406
Mailing Address - Country:US
Mailing Address - Phone:708-478-6470
Mailing Address - Fax:708-478-6471
Practice Address - Street 1:11512 W 183RD ST
Practice Address - Street 2:SUITE NE
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9406
Practice Address - Country:US
Practice Address - Phone:708-478-6470
Practice Address - Fax:708-478-6471
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19403Medicare ID - Type Unspecified
IL204894Medicare UPIN