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General NPI Number Information
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NPI Number | 1891128443
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Entity Type | Individual
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Provider Name | DR. LAURA JARAMILLO
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Gender | Female
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 3040 N WILTON AVE SECOND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60657-4424
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Country | US
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Telephone | 773-296-5603
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Fax | 773-296-5906
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Provider Business Mailing Address
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Address Line | 3040 N WILTON AVE SECOND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60657-4424
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 071008251
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License Number State | IL
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