Healthcare Provider Details

I. General information

NPI: 1083050926
Provider Name (Legal Business Name): ERICA MORAND M. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2013
Last Update Date: 05/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W ONTARIO ST UNIT 325
CHICAGO IL
60654-6942
US

IV. Provider business mailing address

411 W ONTARIO ST UNIT 325
CHICAGO IL
60654-6942
US

V. Phone/Fax

Practice location:
  • Phone: 312-758-1880
  • Fax:
Mailing address:
  • Phone: 312-758-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.007210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: