Provider Demographics
NPI:1700507746
Name:STREETS, AJA
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:STREETS
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 1:15122 QUAIL HOLLOW DR APT 1N
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4073
Mailing Address - Country:US
Mailing Address - Phone:708-559-4879
Mailing Address - Fax:
Practice Address - Street 1:15122 QUAIL HOLLOW DR APT 1N
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4073
Practice Address - Country:US
Practice Address - Phone:708-559-4879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YS0200X
IL178.016415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool