Provider Demographics
NPI:1558065052
Name:NAILON, JALISA
Entity Type:Individual
Prefix:
First Name:JALISA
Middle Name:
Last Name:NAILON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22423 JEAN CT APT 1A
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-2119
Mailing Address - Country:US
Mailing Address - Phone:708-843-1352
Mailing Address - Fax:
Practice Address - Street 1:22423 JEAN CT APT 1A
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-2119
Practice Address - Country:US
Practice Address - Phone:708-843-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty