Healthcare Provider Details

I. General information

NPI: 1417341306
Provider Name (Legal Business Name): MS. ANGELA ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 N CLYBOURN AVE GROUND FLOOR
CHICAGO IL
60618-8269
US

IV. Provider business mailing address

2865 N CLYBOURN AVE GROUND FLOOR
CHICAGO IL
60618-8269
US

V. Phone/Fax

Practice location:
  • Phone: 773-270-0469
  • Fax:
Mailing address:
  • Phone: 773-270-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: