Provider Demographics
NPI:1891128443
Name:JARAMILLO, LAURA
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:JARAMILLO
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 1:3040 N WILTON AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3040 N WILTON AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4424
Practice Address - Country:US
Practice Address - Phone:773-296-5603
Practice Address - Fax:773-296-5906
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008251103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent