Healthcare Provider Details

I. General information

NPI: 1013403922
Provider Name (Legal Business Name): HAILE POLLARD-DURODOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W CONGRESS PKWY
CHICAGO IL
60612-3534
US

IV. Provider business mailing address

4419 N LAWNDALE AVE APT 3A
CHICAGO IL
60625-7121
US

V. Phone/Fax

Practice location:
  • Phone: 773-777-7112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: