Dr Jacqueline Bardwell LTD

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

DR JACQUELINE BARDWELL LTD

Practice address

4403 W Lawrence Ave
Suite 200
Chicago, IL 60630-2513

Phone

(773) 736-1555

Fax

(773) 736-1552

NPI assigned

Oct 28, 2008

Last updated

Oct 28, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jacqueline Bardwell, M.D.

Title

C.E.O.

Phone

(773) 736-1555

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1245483940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 W LAWRENCE AVE",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302513",
            "telephone_number": "773-736-1555",
            "fax_number": "773-736-1552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 W LAWRENCE AVE",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302513",
            "telephone_number": "773-736-1555",
            "fax_number": "773-736-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR JACQUELINE BARDWELL LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "BARDWELL",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "773-736-1555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036071838",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.