Healthcare Provider Details

I. General information

NPI: 1659074417
Provider Name (Legal Business Name): CHEYENNE HAYLEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 W HUBBARD ST STE 1
CHICAGO IL
60654-5537
US

IV. Provider business mailing address

670 W HUBBARD ST STE 1
CHICAGO IL
60654-5537
US

V. Phone/Fax

Practice location:
  • Phone: 844-263-1613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: