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General NPI Number Information
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NPI Number | 1396771697
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Entity Type | Organization
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Legal Business Name | COCREATE PROF CORP
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 3850 N LAWNDALE AVE STE 203
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City | CHICAGO
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State | IL
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Zip | 60618-4115
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Country | US
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Telephone | 773-539-9183
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Fax | 773-509-0874
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Provider Business Mailing Address
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Address Line | 3850 N LAWNDALE AVE STE 203
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City | CHICAGO
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State | IL
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Zip | 60618-4115
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Country | US
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Telephone | 773-539-9183
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Fax | 773-509-0874
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOANN DAKOTA CIMO
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Credential | PHD
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Telephone | 773-539-9183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-006748
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License Number State | IL
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