Healthcare Provider Details

I. General information

NPI: 1396868006
Provider Name (Legal Business Name): CHRISTINE M IRWIN MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 DEMPSTER ST
EVANSTON IL
60202-1017
US

IV. Provider business mailing address

5046 W AINSLIE ST FLR 2
CHICAGO IL
60630-2303
US

V. Phone/Fax

Practice location:
  • Phone: 847-448-8335
  • Fax:
Mailing address:
  • Phone: 847-448-8335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: