Provider Demographics
NPI:1689936312
Name:TUDY SAULS, JASMINE ALLEGRA (MS, MFT)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:ALLEGRA
Last Name:TUDY SAULS
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 BARRON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1327
Mailing Address - Country:US
Mailing Address - Phone:847-231-3840
Mailing Address - Fax:
Practice Address - Street 1:649 BARRON BLVD
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1327
Practice Address - Country:US
Practice Address - Phone:847-231-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000785106H00000X
CAMFC40231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist