Healthcare Provider Details

I. General information

NPI: 1073049268
Provider Name (Legal Business Name): FELICITY DINEEN M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICITY SWEET M.ED.

II. Dates (important events)

Enumeration Date: 05/07/2017
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 PLAINFIELD RD
WILLOWBROOK IL
60527-7607
US

IV. Provider business mailing address

2578 W LYNDALE ST # 2
CHICAGO IL
60647-3154
US

V. Phone/Fax

Practice location:
  • Phone: 239-595-5939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number2059887
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.012924
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: