Healthcare Provider Details

I. General information

NPI: 1952063182
Provider Name (Legal Business Name): JESSICA LONDOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA HOUGSTED

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 N WASHINGTON ST STE 120
NAPERVILLE IL
60563-1335
US

IV. Provider business mailing address

1750 N WASHINGTON ST STE 120
NAPERVILLE IL
60563-1335
US

V. Phone/Fax

Practice location:
  • Phone: 630-315-0021
  • Fax:
Mailing address:
  • Phone: 630-315-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.023234
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: