Provider Demographics
NPI:1306851894
Name:VARGAS, JEAN KINNEY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:KINNEY
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N GREENLEAF ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5710
Mailing Address - Country:US
Mailing Address - Phone:847-213-9909
Mailing Address - Fax:
Practice Address - Street 1:135 N GREENLEAF ST STE 200
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5710
Practice Address - Country:US
Practice Address - Phone:847-213-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0086641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical