Jessica Marie Dergance, LCSW
Individual provider Active NPI Clinical Social Worker · La Salle, IL
NPI 1811293095 · NPPES record last updated Jul 24, 2018
Key facts
- NPI
- 1811293095
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149014277 (IL)
- Practice address
- 2428 Chartres St
La Salle, IL 61301-1107 - Phone
- (815) 780-8765
- Fax
- (815) 780-8766
- NPI assigned
- Feb 4, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Life Balance Counseling and Wellness Inc
Practice addresses (Care Compare)
2218 Marquette Rd
Peru, IL 61354-1538
Phone (815) 780-8765
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110504000205 | IL | Practitioner - Clinical Social Worker | 8628253820 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149014277 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life Balance Counseling and Wellness Inc | Clinical | Current |
Accepting new patients |
Locations
2428 Chartres St
La Salle, IL 61301
Phone (309) 830-1096
2218 Marquette Rd
Peru, IL 61354
Phone (815) 223-7970
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149014277 | IL | Yes |
Addresses
Primary practice location
2428 Chartres St
La Salle, IL 61301-1107
Mailing address
2428 Chartres St
La Salle, IL 61301-1107
Phone (815) 224-1610
Other providers in La Salle, IL
- Kelley B Conley
- Cornerstone Counseling
- Maryfrances Crist
- Elizabeth M Davis
- John James Derango
- Dimmick CC School Dist 175
- Dr Nicholas M Tabor III DPM
- Dr William White PC
- Karen R. Dunne
- Christine Eimer
All providers in La Salle, 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 Jul 24, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.