Healthcare Provider Details

I. General information

NPI: 1174451504
Provider Name (Legal Business Name): ISABEL BORATAV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 N DAMEN AVE
CHICAGO IL
60647-5511
US

IV. Provider business mailing address

1806 N DAMEN AVE
CHICAGO IL
60647-5511
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 TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022887
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: