Provider Demographics
NPI:1649064825
Name:SERRALDE, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SERRALDE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 PETERSON AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5100
Mailing Address - Country:US
Mailing Address - Phone:847-370-2569
Mailing Address - Fax:
Practice Address - Street 1:555 WILSON LN
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4729
Practice Address - Country:US
Practice Address - Phone:847-370-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker