Provider Demographics
NPI:1215492855
Name:SANTIAGO, JENNIFER (LCPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 S ASHLAND AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1849
Mailing Address - Country:US
Mailing Address - Phone:630-300-4155
Mailing Address - Fax:
Practice Address - Street 1:33 S ASHLAND AVE APT 405
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1849
Practice Address - Country:US
Practice Address - Phone:630-300-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional