MEDICARE: PRECIOUS-DIAMOND SANDRE'A CHESSIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1841096617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRECIOUS-DIAMOND SANDRE'A CHESSIER

Provider Business Mailing Address
First Line	:	10452 S KEDZIE AVE # 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2018
Country	:	US
Telephone Number	:	205-534-4966
Fax Number	:	205-534-4966

Provider Business Practice Location Address
First Line	:	10452 S KEDZIE AVE # 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2018
Country	:	US
Telephone Number	:	205-534-4966
Fax Number	:	205-534-4966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2025
Last Update Date	:	02/21/2025

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