Healthcare Provider Details

I. General information

NPI: 1598911562
Provider Name (Legal Business Name): MARISOL A. OSUCH M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 W CERMAK RD
CICERO IL
60804-2817
US

IV. Provider business mailing address

5341 W CERMAK RD
CICERO IL
60804-2817
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-6430
  • Fax: 708-656-6591
Mailing address:
  • Phone: 708-656-6430
  • Fax: 708-656-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: