Healthcare Provider Details

I. General information

NPI: 1316784366
Provider Name (Legal Business Name): HALEY BLACKWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N OAK PARK AVE
CHICAGO IL
60707-3351
US

IV. Provider business mailing address

2211 N OAK PARK AVE
CHICAGO IL
60707-3351
US

V. Phone/Fax

Practice location:
  • Phone: 773-622-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: