Healthcare Provider Details

I. General information

NPI: 1871215285
Provider Name (Legal Business Name): CHINYERE OKORO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 W MONTROSE AVE
CHICAGO IL
60618-1521
US

IV. Provider business mailing address

1335 W ELMDALE AVE APT 3
CHICAGO IL
60660-4197
US

V. Phone/Fax

Practice location:
  • Phone: 414-292-7748
  • Fax:
Mailing address:
  • Phone: 414-292-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: