Healthcare Provider Details

I. General information

NPI: 1710878053
Provider Name (Legal Business Name): JENNIFER OSAGIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNA OSAGIE-EGBON

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7666 W 63RD ST
SUMMIT IL
60501-1812
US

IV. Provider business mailing address

5220 EAST AVE
COUNTRYSIDE IL
60525-3133
US

V. Phone/Fax

Practice location:
  • Phone: 708-745-5277
  • Fax:
Mailing address:
  • Phone: 708-745-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: