Individual ProviderJessica MorenoSocial WorkerBehavioral Health & Social Service ProvidersPractice Address2451 N Lincoln Ave, Chicago, IL 60614-1509(773) 496-6675(312) 722-8347PECOS EnrollmentBased on the most recent information from CMS, provider Jessica Moreno 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 ID1912630468Provider TypeIndividualFull NameMoreno, JessicaCredentialLCSWGenderFemaleSole ProprietorNoEnumeration Date7/1/2022Last Updated5/10/2023Contact InformationPractice LocationPractice Address2451 N Lincoln Ave, Chicago, IL 60614-1509Phone(773) 496-6675FaxUnlisted FaxMailing LocationMailing Address5841 S Maryland Ave, Chicago, IL 60637-1443Phone(312) 722-8347FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense149025403IllinoisCode104100000XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode171M00000XDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer