Healthcare Provider Details

I. General information

NPI: 1891619508
Provider Name (Legal Business Name): DALILA ANDREA CHACON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 LAKE ST STE 273
OAK PARK IL
60301-1411
US

IV. Provider business mailing address

3135 N AUSTIN AVE
CHICAGO IL
60634-5103
US

V. Phone/Fax

Practice location:
  • Phone: 773-312-3612
  • Fax:
Mailing address:
  • Phone: 773-977-6825
  • 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: