Healthcare Provider Details

I. General information

NPI: 1154089183
Provider Name (Legal Business Name): CYNTHIA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ROHLWING RD
ELK GROVE VILLAGE IL
60007-3217
US

IV. Provider business mailing address

3610 EUCLID AVE
BERWYN IL
60402-3863
US

V. Phone/Fax

Practice location:
  • Phone: 847-524-8800
  • Fax:
Mailing address:
  • Phone: 708-805-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: