Healthcare Provider Details

I. General information

NPI: 1790795805
Provider Name (Legal Business Name): BNM PROFESSIONAL CONSULTING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 LINCOLN MALL DR SUITE #302
MATTESON IL
60443-3811
US

IV. Provider business mailing address

4747 LINCOLN MALL DR SUITE #302
MATTESON IL
60443-3811
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-0680
  • Fax: 708-679-0683
Mailing address:
  • Phone: 708-679-0680
  • Fax: 708-679-0683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. DIANE VENNESSA DAVIS-WILLIAMS
Title or Position: PRESIDENT
Credential: ED.D.
Phone: 708-679-0680