Individual
EASTER JEAN WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8049 S SACRAMENTO AVE, CHICAGO, IL 60652-2732
(773) 306-1570
(773) 306-1571
Mailing address
8049 S SACRAMENTO AVE, CHICAGO, IL 60652-2732
(773) 306-1570
(773) 306-1571
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17965
MISA II
IL
01
—
21722
PCGC
IL
01
—
22134
CCJP
IL
01
—
EW44070604P
EARLY INTERVENTION SPEC.
IL
01
—
ICCSO1140
CCS
IL
Enumeration date
05/27/2007
Last updated
07/08/2007
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