Healthcare Provider Details

I. General information

NPI: 1205207925
Provider Name (Legal Business Name): HUONG IODICE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HUONG HO N/A

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W HARRISON ST
CHICAGO IL
60612-3706
US

IV. Provider business mailing address

2150 W HARRISON ST
CHICAGO IL
60612-3706
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5375
  • Fax: 312-942-3113
Mailing address:
  • Phone: 312-942-5375
  • Fax: 312-942-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277003555
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: