Healthcare Provider Details

I. General information

NPI: 1295402972
Provider Name (Legal Business Name): MICHELLE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 N RAVENSWOOD AVE UNIT 227
CHICAGO IL
60640-4417
US

IV. Provider business mailing address

4829 N DAMEN AVE APT 303
CHICAGO IL
60625-1467
US

V. Phone/Fax

Practice location:
  • Phone: 312-574-0750
  • Fax:
Mailing address:
  • Phone: 312-838-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: