Healthcare Provider Details

I. General information

NPI: 1104773613
Provider Name (Legal Business Name): JADI ENGELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W RAND RD
MOUNT PROSPECT IL
60056-1132
US

IV. Provider business mailing address

220 W RAND RD
MOUNT PROSPECT IL
60056-1132
US

V. Phone/Fax

Practice location:
  • Phone: 650-622-6811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: