Provider Demographics
NPI:1033861042
Name:LANGOSCH, JAIME MARIE
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:MARIE
Last Name:LANGOSCH
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 1:10633 PENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2793
Mailing Address - Country:US
Mailing Address - Phone:708-307-2084
Mailing Address - Fax:
Practice Address - Street 1:1754 N WASHINGTON ST STE 104A
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1462
Practice Address - Country:US
Practice Address - Phone:630-995-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178017762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health