Jacquelin Diane Ejka, LCSW
Individual provider Active NPI Clinical Social Worker · Washington, IL
NPI 1083070940 · NPPES record last updated Jan 7, 2016
Key facts
- NPI
- 1083070940
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149.014899 (IL)
- Practice address
- 1003 N Cummings LN
Washington, IL 61571-9646 - Phone
- (309) 444-1000
- Fax
- (309) 444-7000
- NPI assigned
- Jan 7, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.014899 | IL | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.014899 | IL | Yes |
Addresses
Primary practice location
1003 N Cummings LN
Washington, IL 61571-9646
Mailing address
1003 N Cummings LN
Washington, IL 61571-9646
Phone (309) 444-1000
Other providers in Washington, IL
- Brittany J Drury
- Patricia A Duckwiler
- Alecsander Dutko
- Kimberly Ann Earle
- Caitlin Mary Eigsti
- Joelle Renee Elmore
- Leah Embree
- Katherine J Engelke
- David J England
- Courtney E Erickson
All providers in Washington, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.