Provider Demographics
NPI:1063210300
Name:SALAZAR, JESUS (MSW, LSW)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-4066
Mailing Address - Country:US
Mailing Address - Phone:217-220-7479
Mailing Address - Fax:
Practice Address - Street 1:850 S MCHENRY AVE STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7442
Practice Address - Country:US
Practice Address - Phone:815-455-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.114970104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker