Provider Demographics
NPI:1194233080
Name:SALICHS, AGNES DE LAS MERCEDES (EDD)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:DE LAS MERCEDES
Last Name:SALICHS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 YORKSHIRE CT APT B
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-7115
Mailing Address - Country:US
Mailing Address - Phone:787-486-2425
Mailing Address - Fax:630-839-9024
Practice Address - Street 1:1804 IRVING PARK RD STE A
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-3254
Practice Address - Country:US
Practice Address - Phone:773-965-1220
Practice Address - Fax:630-839-9024
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR176101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor