Healthcare Provider Details

I. General information

NPI: 1417801838
Provider Name (Legal Business Name): DAIZHA HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20280 GOVERNORS HWY STE 105
OLYMPIA FIELDS IL
60461-1068
US

IV. Provider business mailing address

20280 GOVERNORS HWY STE 105
OLYMPIA FIELDS IL
60461-1068
US

V. Phone/Fax

Practice location:
  • Phone: 312-248-3481
  • Fax: 312-872-8391
Mailing address:
  • Phone: 312-248-3481
  • Fax: 312-872-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022805
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: