Healthcare Provider Details

I. General information

NPI: 1932062874
Provider Name (Legal Business Name): EVELYN CAMACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 W ADAMS ST
CHICAGO IL
60607-2801
US

IV. Provider business mailing address

1750 W WABANSIA AVE # 1R
CHICAGO IL
60622-1446
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-8487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88095
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: