Healthcare Provider Details

I. General information

NPI: 1831663178
Provider Name (Legal Business Name): JESSICA SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 N ASHLAND AVE
CHICAGO IL
60614-2020
US

IV. Provider business mailing address

2409 N CLYBOURN AVE
CHICAGO IL
60614-6185
US

V. Phone/Fax

Practice location:
  • Phone: 773-755-1775
  • Fax:
Mailing address:
  • Phone: 773-755-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.013152
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: