Healthcare Provider Details

I. General information

NPI: 1174014716
Provider Name (Legal Business Name): ENTREPRENEUR ENTERPRIZEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 W WALNUT ST
CHICAGO IL
60612-1835
US

IV. Provider business mailing address

3017 W WALNUT ST
CHICAGO IL
60612-1835
US

V. Phone/Fax

Practice location:
  • Phone: 682-772-9133
  • Fax:
Mailing address:
  • Phone: 682-772-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number785049
License Number StateIL

VIII. Authorized Official

Name: MISS BRIDGETT SHAUNTELL WHOOPER
Title or Position: DIRECTOR
Credential: COUNSELOR
Phone: 682-772-9133