Provider Demographics
NPI:1164598660
Name:MALLINGER, JACQUELINE SONNENBERG (MSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SONNENBERG
Last Name:MALLINGER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:EMILY
Other - Last Name:SONNENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:1183 GAIL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089
Mailing Address - Country:US
Mailing Address - Phone:847-821-0957
Mailing Address - Fax:
Practice Address - Street 1:355 WEST DUNDEE
Practice Address - Street 2:SUITE 209
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089
Practice Address - Country:US
Practice Address - Phone:847-821-0957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1605848OtherBLUE CROSS BLUE SHIELD