Healthcare Provider Details

I. General information

NPI: 1508278482
Provider Name (Legal Business Name): VANESSA CHEVON HOLLAND AAHCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 N PERIWINKLE WAY
ROUND LAKE BEACH IL
60073-4038
US

IV. Provider business mailing address

2401 N PERIWINKLE WAY
ROUND LAKE BEACH IL
60073-4038
US

V. Phone/Fax

Practice location:
  • Phone: 847-219-7345
  • Fax:
Mailing address:
  • Phone: 847-219-7345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberBRADLEY METHOD AAHCC
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberBRADLEY DOULA, AAHCC
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: