Healthcare Provider Details

I. General information

NPI: 1215701610
Provider Name (Legal Business Name): SAMIRE QOSAJ NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 SHERMER RD STE 280
NORTHBROOK IL
60062-4589
US

IV. Provider business mailing address

1340 SHERMER RD STE 280
NORTHBROOK IL
60062-4589
US

V. Phone/Fax

Practice location:
  • Phone: 312-620-0217
  • Fax:
Mailing address:
  • Phone: 312-620-0217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.020217
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: