Provider Demographics
NPI:1679833453
Name:BOBLICK-URIBE, JESSICA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:BOBLICK-URIBE
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 1:2741 W WINNEMAC AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3675
Mailing Address - Country:US
Mailing Address - Phone:708-548-5273
Mailing Address - Fax:708-995-3803
Practice Address - Street 1:2741 W WINNEMAC AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3675
Practice Address - Country:US
Practice Address - Phone:708-548-5273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490186601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical