Healthcare Provider Details

I. General information

NPI: 1154143279
Provider Name (Legal Business Name): MICHELLE PAGELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24402 W. LOCKPORT STREET SUITE 108
PLAINFIELD IL
60544
US

IV. Provider business mailing address

24402 W. LOCKPORT STREET SUITE 108
PLAINFIELD IL
60544
US

V. Phone/Fax

Practice location:
  • Phone: 630-544-7008
  • Fax:
Mailing address:
  • Phone: 630-544-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180006785
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: