Active NPI
Jacqueline Eileen Estrada, EDD
- School Psychologist
- Chicago, IL
National Provider Identifier
1033972120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 2417811
- Practice address
- 6058 S Tripp Ave
Chicago, IL 60629-4925 - Phone
- (773) 993-4238
- NPI assigned
- Feb 1, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 178.017419 | IL | |
| School Psychologist | 103TS0200X | 2417811 | IL | Primary |
Addresses
Primary practice location
6058 S Tripp Ave
Chicago, IL 60629-4925
Mailing address
6058 S Tripp Ave
Chicago, IL 60629-4925
Phone (773) 993-4238
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.017419 | IL | MD | Mental Health Counselor |
| 2417811 | IL | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706745600000",
"number": "1033972120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6058 S TRIPP AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606294925",
"telephone_number": "773-993-4238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6058 S TRIPP AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606294925",
"telephone_number": "773-993-4238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ESTRADA",
"first_name": "JACQUELINE",
"middle_name": "EILEEN",
"name_prefix": "Dr.",
"credential": "EDD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-01",
"last_updated": "2024-02-01",
"certification_date": "2024-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "178.017419",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "IL",
"license": "2417811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.