Most Relevant Information
Provider Data
| NPI Number: | 1003343096 |
| Provider Name: | JORGE ROMAN |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/22/2017 |
| Last Updated: | 04/12/2022 |
Provider Practice Location
650 DAKOTA ST STE A
CRYSTAL LAKE
IL
600123744
Practice Location Phone/Fax
| Phone: | 8153345018 |
| Fax: | 8153561104 |
Provider Mailing Location
650 DAKOTA ST STE A
CRYSTAL LAKE
IL
600123744
Provider Mailing Phone/Fax
| Phone: | 8153345018 |
| Fax: | 8153561104 |