Provider Demographics
NPI:1760057129
Name:VALENCIA PEREZ, XIMENA
Entity Type:Individual
Prefix:
First Name:XIMENA
Middle Name:
Last Name:VALENCIA PEREZ
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 1:10 E ONTARIO ST APT 4903
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2763
Mailing Address - Country:US
Mailing Address - Phone:312-838-4433
Mailing Address - Fax:
Practice Address - Street 1:2259 S DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4232
Practice Address - Country:US
Practice Address - Phone:872-281-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional