Healthcare Provider Details

I. General information

NPI: 1194207522
Provider Name (Legal Business Name): CINDY LOUISE LYS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2018
Last Update Date: 09/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E 53RD STREET SUITE 516-4
CHICAGO IL
60615
US

IV. Provider business mailing address

7425 S SUTH SHORE DRIVE 3H
CHICAGO IL
60649
US

V. Phone/Fax

Practice location:
  • Phone: 224-444-9056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.018299
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: