Healthcare Provider Details

I. General information

NPI: 1134048358
Provider Name (Legal Business Name): ADRIA JAEL HAMILTON MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 N WATER TOWER PL
MOUNT VERNON IL
62864-6295
US

IV. Provider business mailing address

2455 WALNUT HILL RD
WALNUT HILL IL
62893-1246
US

V. Phone/Fax

Practice location:
  • Phone: 773-720-7089
  • Fax:
Mailing address:
  • Phone: 618-306-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: