Healthcare Provider Details

I. General information

NPI: 1629592894
Provider Name (Legal Business Name): ELIZEJOY OCAMPO GUZZARDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZEJOY OCAMPO

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 N CICERO AVE STE 630
CHICAGO IL
60646-4325
US

IV. Provider business mailing address

1448 N MILWAUKEE AVE
CHICAGO IL
60622-9225
US

V. Phone/Fax

Practice location:
  • Phone: 773-932-9597
  • Fax: 773-243-0519
Mailing address:
  • Phone: 312-476-9064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.012677
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: