Healthcare Provider Details

I. General information

NPI: 1396543161
Provider Name (Legal Business Name): AYMA SIDDIQUI M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 MAIN ST MELROSE PARK, IL 60160
MELROSE PARK IL
60160
US

IV. Provider business mailing address

4533 N LAWNDALE AVE
CHICAGO IL
60625-5917
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-0073
  • Fax: 708-681-3958
Mailing address:
  • Phone: 773-654-8459
  • 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: