Provider Demographics
NPI:1437625183
Name:MALAGON, JOSE MANUEL JR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:MALAGON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 WHIRLAWAY CT
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1300
Mailing Address - Country:US
Mailing Address - Phone:219-629-4416
Mailing Address - Fax:
Practice Address - Street 1:1784 WHIRLAWAY CT
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1300
Practice Address - Country:US
Practice Address - Phone:219-629-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149020200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health