Provider Demographics
NPI:1053788331
Name:ANDERSON-GONZALEZ, JESSICA LYNNE (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:ANDERSON-GONZALEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25800 S BASSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-3397
Mailing Address - Country:US
Mailing Address - Phone:779-379-2654
Mailing Address - Fax:
Practice Address - Street 1:350 HOUBOLT RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8305
Practice Address - Country:US
Practice Address - Phone:779-379-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0177151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical