Healthcare Provider Details

I. General information

NPI: 1629732789
Provider Name (Legal Business Name): NATALIE ABDULLAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W DEVON AVE STE 507
CHICAGO IL
60646-4540
US

IV. Provider business mailing address

4001 W DEVON AVE STE 507
CHICAGO IL
60646-4540
US

V. Phone/Fax

Practice location:
  • Phone: 773-657-3084
  • Fax: 773-657-3061
Mailing address:
  • Phone: 773-657-3084
  • Fax: 773-657-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: