Provider Demographics
NPI:1053811992
Name:GONZALEZ, JASMINE (LSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:377 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-5756
Mailing Address - Country:US
Mailing Address - Phone:815-707-4806
Mailing Address - Fax:
Practice Address - Street 1:377 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-5756
Practice Address - Country:US
Practice Address - Phone:815-707-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2025-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-20892104100000X
IL150.112690104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL150.112690OtherLSW