Healthcare Provider Details

I. General information

NPI: 1932770799
Provider Name (Legal Business Name): MS. ACES RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 W WILSON AVE # 5108
CHICAGO IL
60640-5255
US

IV. Provider business mailing address

2249 N SPRINGFIELD AVE
CHICAGO IL
60647-2217
US

V. Phone/Fax

Practice location:
  • Phone: 866-726-7170
  • Fax:
Mailing address:
  • Phone: 773-318-7872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178014665
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: