Healthcare Provider Details

I. General information

NPI: 1073802054
Provider Name (Legal Business Name): VANESSA HERMOSILLO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 S GENEVA ST
ELGIN IL
60120-6581
US

IV. Provider business mailing address

37 S GENEVA ST
ELGIN IL
60120-6581
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-2380
  • Fax:
Mailing address:
  • Phone: 847-697-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178006922
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: