Healthcare Provider Details

I. General information

NPI: 1093284317
Provider Name (Legal Business Name): PULLEY AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 72ND ST
CHICAGO IL
60619-1511
US

IV. Provider business mailing address

1501 E 72ND ST
CHICAGO IL
60619-1511
US

V. Phone/Fax

Practice location:
  • Phone: 773-407-7558
  • Fax: 312-528-0105
Mailing address:
  • Phone: 773-407-7558
  • Fax: 312-528-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBRA A STEWART
Title or Position: DEVELOPENTAL THERAPIST
Credential:
Phone: 773-407-7558