Healthcare Provider Details

I. General information

NPI: 1861844730
Provider Name (Legal Business Name): EMILY CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 RIDGE AVE 2ND FL
EVANSTON IL
60202-3328
US

IV. Provider business mailing address

854 N MOZART ST 1ST FL
CHICAGO IL
60622-4416
US

V. Phone/Fax

Practice location:
  • Phone: 847-316-6262
  • Fax:
Mailing address:
  • Phone: 308-383-4207
  • Fax:

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: