Healthcare Provider Details

I. General information

NPI: 1932011525
Provider Name (Legal Business Name): ERICA JOY OPERANA AGUDELO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAKE ST STE 503
OAK PARK IL
60301-1135
US

IV. Provider business mailing address

1010 LAKE ST STE 503
OAK PARK IL
60301-1135
US

V. Phone/Fax

Practice location:
  • Phone: 708-888-0491
  • Fax:
Mailing address:
  • Phone: 708-888-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149029246
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: