Provider Demographics
NPI:1881556256
Name:VILLEGAS, JAQUANDA MICHELLE
Entity type:Individual
Prefix:
First Name:JAQUANDA
Middle Name:MICHELLE
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAQUANDA
Other - Middle Name:MICHELLE
Other - Last Name:SAULTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6524 S SAINT LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-3331
Mailing Address - Country:US
Mailing Address - Phone:773-550-3849
Mailing Address - Fax:
Practice Address - Street 1:4755 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5051
Practice Address - Country:US
Practice Address - Phone:773-550-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILS436-4337-4776261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing