Provider Demographics
NPI:1326702564
Name:UREWICZ, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:UREWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2779 THEATRE RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53191-3725
Mailing Address - Country:US
Mailing Address - Phone:224-639-2087
Mailing Address - Fax:
Practice Address - Street 1:350 CONSTANCE BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-9547
Practice Address - Country:US
Practice Address - Phone:262-245-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker