Healthcare Provider Details

I. General information

NPI: 1437873197
Provider Name (Legal Business Name): JENNY UGALDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W JOHN ST
YORKVILLE IL
60560-9249
US

IV. Provider business mailing address

811 W JOHN ST
YORKVILLE IL
60560-9249
US

V. Phone/Fax

Practice location:
  • Phone: 630-553-9100
  • Fax: 630-553-0167
Mailing address:
  • Phone: 630-553-9100
  • Fax: 630-553-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: