Healthcare Provider Details

I. General information

NPI: 1295111680
Provider Name (Legal Business Name): XIA LING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 S SANGAMON ST UNIT 714
CHICAGO IL
60608-2239
US

IV. Provider business mailing address

1524 S SANGAMON ST UNIT 714
CHICAGO IL
60608-2239
US

V. Phone/Fax

Practice location:
  • Phone: 312-493-4822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: