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General NPI Number Information
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NPI Number | 1598429714
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Entity Type | Organization
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Legal Business Name | FEATHERFIST
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 2255 E 75TH ST
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City | CHICAGO
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State | IL
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Zip | 60649-3228
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Country | US
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Telephone | 773-721-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 2255 E 75TH ST
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City | CHICAGO
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State | IL
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Zip | 60649-3228
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Country | US
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Telephone | 773-721-7088
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MELANIE ANEWISHKI
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Credential | EDD
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Telephone | 773-721-7088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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