Jesse Bashaw
Individual provider Active NPI Social Worker · Mount Carroll, IL
NPI 1235529397 · NPPES record last updated Jan 28, 2015
Key facts
- NPI
- 1235529397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- Practice address
- 1126 Healthcare Dr
Mount Carroll, IL 61058-1469 - Phone
- (815) 244-4200
- NPI assigned
- Jan 28, 2015
- Sex
- Male
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Yes |
Addresses
Primary practice location
1126 Healthcare Dr
Mount Carroll, IL 61058-1469
Mailing address
1126 Healthcare Dr
Mount Carroll, IL 61058-1469
Phone (815) 244-4200
Other providers in Mount Carroll, IL
- Kathleen Allen
- Allure of Mt Carroll, LLC
- Alice Andrews
- Eric J Bader
- Matthew Thomas Becker
- Jeremy Caleb Bleuer
- Katelin Marie Breuning
- Carroll County Health Department
- Sharon Kay Chadwick
All providers in Mount Carroll, IL · 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 28, 2015. 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.