Healthcare Provider Details

I. General information

NPI: 1245828011
Provider Name (Legal Business Name): MIKAYLA WEITZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 S CICERO AVE
OAK LAWN IL
60453-4098
US

IV. Provider business mailing address

10201 S CICERO AVE
OAK LAWN IL
60453-4098
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-3675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150104537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: