Healthcare Provider Details

I. General information

NPI: 1447077458
Provider Name (Legal Business Name): CHANTELL SHAMAR HEARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2024
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 N MILWAUKEE AVE
CHICAGO IL
60618-7886
US

IV. Provider business mailing address

8521 S KARLOV AVE
CHICAGO IL
60652-3603
US

V. Phone/Fax

Practice location:
  • Phone: 800-206-8136
  • Fax:
Mailing address:
  • Phone: 773-444-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: