Healthcare Provider Details

I. General information

NPI: 1114680055
Provider Name (Legal Business Name): ENVISION UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 S MICHIGAN AVE STE 1700
CHICAGO IL
60603-3353
US

IV. Provider business mailing address

8 S MICHIGAN AVE STE 1700
CHICAGO IL
60603-3353
US

V. Phone/Fax

Practice location:
  • Phone: 872-895-7942
  • Fax: 800-391-8460
Mailing address:
  • Phone: 872-895-7942
  • Fax: 800-391-8460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAMEERA J JACKSON-REYES
Title or Position: OFFICE MANAGER
Credential:
Phone: 872-270-2349