Healthcare Provider Details

I. General information

NPI: 1669061826
Provider Name (Legal Business Name): MS. NOSHEEN SIDDIQUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 ROOSEVELT RD
FOREST PARK IL
60130-2529
US

IV. Provider business mailing address

6438 N SPAULDING AVE
LINCOLNWOOD IL
60712-3817
US

V. Phone/Fax

Practice location:
  • Phone: 708-771-7000
  • Fax:
Mailing address:
  • Phone: 773-656-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: