Healthcare Provider Details

I. General information

NPI: 1982528931
Provider Name (Legal Business Name): EVELYN HADDAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6018 N DRAKE AVE
CHICAGO IL
60659-3207
US

IV. Provider business mailing address

2301 COVINGTON CT
PLAINFIELD IL
60586-1684
US

V. Phone/Fax

Practice location:
  • Phone: 872-328-5881
  • Fax:
Mailing address:
  • Phone: 312-399-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: