Healthcare Provider Details

I. General information

NPI: 1588124010
Provider Name (Legal Business Name): CHYAIRE MICHELLE BROWN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 W CERMAK RD
CHICAGO IL
60608-4204
US

IV. Provider business mailing address

1902 W CERMAK RD
CHICAGO IL
60608-4204
US

V. Phone/Fax

Practice location:
  • Phone: 773-596-9045
  • Fax: 773-360-8379
Mailing address:
  • Phone: 773-596-9045
  • Fax: 773-360-8379

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: