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: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4908 N ELSTON AVE
CHICAGO IL
60630-2506
US

IV. Provider business mailing address

1353 E MAIN ST
BROWNSBURG IN
46112-1433
US

V. Phone/Fax

Practice location:
  • Phone: 773-205-8505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-198994
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: