Provider Demographics
NPI:1700270493
Name:AZPILCUETA, JONATAN (HD)
Entity Type:Individual
Prefix:MR
First Name:JONATAN
Middle Name:
Last Name:AZPILCUETA
Suffix:
Gender:M
Credentials:HD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 SCOVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1908
Mailing Address - Country:US
Mailing Address - Phone:708-715-7376
Mailing Address - Fax:
Practice Address - Street 1:1830 SCOVILLE AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1908
Practice Address - Country:US
Practice Address - Phone:708-715-7376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker