Individual ProviderJackeline MitchellSocial WorkerBehavioral Health & Social Service ProvidersPractice Address4815 W Barry Ave, Chicago, IL 60641-5103(773) 990-0939PECOS EnrollmentBased on the most recent information from CMS, provider Jackeline Mitchell does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1649944679Provider TypeIndividualFull NameMitchell, JackelineCredentialLCSWGenderFemaleSole ProprietorYesEnumeration Date8/3/2021Last Updated8/3/2021Contact InformationPractice LocationPractice Address4815 W Barry Ave, Chicago, IL 60641-5103Phone(773) 990-0939FaxUnlisted FaxMailing LocationMailing Address4815 W Barry Ave, Chicago, IL 60641-5103Phone(773) 990-0939FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense149023607Illinois