| Doctor Name: | MS. JESSICA MARIE DERGANCE |
| NPI Number: | 1811293095 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 149014277 |
| Business Practice Address: | 2960 Chartres St La Salle, IL - 613011097 |
| Business Phone Number: | 8152241610 |
| Business Fax Number: | 8152231634 |
| Mailing Address: | 2960 Chartres St, P.o. Box 1488 LA SALLE |
| State: | IL |
| Postal Code: | 613011097 |
| Phone Number: | 8152241610 |
| Fax Number: | 8152231634 |
| NPI Enumeration Date: | 02/04/2011 |
| NPI Last Update Date: | 02/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149014277 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |