Healthcare Provider Details

I. General information

NPI: 1174436323
Provider Name (Legal Business Name): MI'QUEEN REESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 S AUSTIN BLVD APT 3W
OAK PARK IL
60304-2340
US

IV. Provider business mailing address

814 S AUSTIN BLVD APT 3W
OAK PARK IL
60304-2340
US

V. Phone/Fax

Practice location:
  • Phone: 630-272-1733
  • Fax:
Mailing address:
  • Phone: 630-272-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: