Provider Demographics
NPI:1497416002
Name:JARAMILLO, ALICIA M (LCPC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:JARAMILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:3812 W EDDY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5014
Mailing Address - Country:US
Mailing Address - Phone:517-927-9086
Mailing Address - Fax:
Practice Address - Street 1:3812 W EDDY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5014
Practice Address - Country:US
Practice Address - Phone:517-927-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014809101YP2500X
IL180.014223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional