Provider Demographics
NPI:1518452093
Name:CAES, JONATHAN LEE
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LEE
Last Name:CAES
Suffix:
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 1:413 BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6806
Mailing Address - Country:US
Mailing Address - Phone:708-446-1059
Mailing Address - Fax:
Practice Address - Street 1:201 E OGDEN AVE STE 106
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3686
Practice Address - Country:US
Practice Address - Phone:855-543-7687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0004951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical