1134508013 NPI number — MRS. JAMILYN LOUISE DESANTI MSW, LSW

Table of content: MRS. JAMILYN LOUISE DESANTI MSW, LSW (NPI 1134508013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134508013 NPI number — MRS. JAMILYN LOUISE DESANTI MSW, LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESANTI
Provider First Name:
JAMILYN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMOLIK
Provider Other First Name:
JAMILYN
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134508013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11447 2ND ST STE 9B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSCOE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61073-9522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-290-6705
Provider Business Mailing Address Fax Number:
630-892-0027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11447 2ND ST.
Provider Second Line Business Practice Location Address:
#96
Provider Business Practice Location Address City Name:
ROSCOE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-601-4673
Provider Business Practice Location Address Fax Number:
866-303-8062
Provider Enumeration Date:
05/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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