Provider Demographics
NPI:1245936350
Name:JUGO, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:JUGO
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 1:2100 WALNUT CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1248
Mailing Address - Country:US
Mailing Address - Phone:847-219-5877
Mailing Address - Fax:
Practice Address - Street 1:2610 LAKE COOK RD STE 133
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-5710
Practice Address - Country:US
Practice Address - Phone:847-219-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor