Provider Demographics
NPI:1861861122
Name:MOLER, JAMIE (MSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MOLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 N KEDZIE AVE
Mailing Address - Street 2:APT #201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4501
Mailing Address - Country:US
Mailing Address - Phone:312-351-1137
Mailing Address - Fax:
Practice Address - Street 1:216 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-6909
Practice Address - Country:US
Practice Address - Phone:312-673-2729
Practice Address - Fax:312-553-5536
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker