Provider Demographics
NPI:1548794191
Name:BOWEN, JESSICA (MSW, LCSW)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W MADISON ST
Mailing Address - Street 2:2413
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2713
Mailing Address - Country:US
Mailing Address - Phone:312-256-5874
Mailing Address - Fax:
Practice Address - Street 1:2000 N RACINE AVE
Practice Address - Street 2:3300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4045
Practice Address - Country:US
Practice Address - Phone:312-256-5874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0171041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical