Healthcare Provider Details

I. General information

NPI: 1972408193
Provider Name (Legal Business Name): DAZJE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 LEWIS AVE
ZION IL
60099-2179
US

IV. Provider business mailing address

2307 LEWIS AVE FRNT 2
ZION IL
60099-2179
US

V. Phone/Fax

Practice location:
  • Phone: 773-895-5916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: