Healthcare Provider Details

I. General information

NPI: 1891064101
Provider Name (Legal Business Name): CHIARA DI MEGLIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 W CARROLL AVE
CHICAGO IL
60607-1105
US

IV. Provider business mailing address

1409 W CARROLL AVE
CHICAGO IL
60607-1105
US

V. Phone/Fax

Practice location:
  • Phone: 312-733-0883
  • Fax:
Mailing address:
  • Phone: 312-733-0883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: