Healthcare Provider Details

I. General information

NPI: 1710456785
Provider Name (Legal Business Name): NATALIE VELAZQUEZ MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N WOLF RD
WHEELING IL
60090-2922
US

IV. Provider business mailing address

1111 W LAKE COOK RD
BUFFALO GROVE IL
60089-1926
US

V. Phone/Fax

Practice location:
  • Phone: 847-353-1500
  • Fax:
Mailing address:
  • Phone: 847-353-1758
  • 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: