Provider Demographics
NPI:1427769306
Name:SAMPERIO, JESSICA (MSW, LCSW, PEL)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:SAMPERIO
Suffix:
Gender:F
Credentials:MSW, LCSW, PEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 W CHASE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2384
Mailing Address - Country:US
Mailing Address - Phone:312-523-1730
Mailing Address - Fax:
Practice Address - Street 1:1816 W CHASE AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2384
Practice Address - Country:US
Practice Address - Phone:312-552-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL25701971041S0200X
IL1490234781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool