Provider Demographics
NPI:1972319119
Name:WADJET-MCGILL-NIXON-JORDAN, UJO
Entity type:Individual
Prefix:
First Name:UJO
Middle Name:
Last Name:WADJET-MCGILL-NIXON-JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 S UNION AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-4499
Mailing Address - Country:US
Mailing Address - Phone:312-833-5640
Mailing Address - Fax:
Practice Address - Street 1:6127 S UNIVERSITY AVE STE 109
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-7418
Practice Address - Country:US
Practice Address - Phone:773-234-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health