Provider Demographics
NPI:1740801174
Name:BERLINGHOF, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BERLINGHOF
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 1:157 N MILWAUKEE AVE APT 512
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8785
Mailing Address - Country:US
Mailing Address - Phone:847-293-8123
Mailing Address - Fax:
Practice Address - Street 1:220 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE PARK
Practice Address - State:IL
Practice Address - Zip Code:60073-3444
Practice Address - Country:US
Practice Address - Phone:847-270-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool