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General NPI Number Information
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NPI Number | 1679109383
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Entity Type | Individual
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Provider Name | CHRISTINA CHICO
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Gender | Female
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Dates
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Enumeration Date | 03/14/2020
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 7146 183RD ST STE 160
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City | TINLEY PARK
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State | IL
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Zip | 60477-3933
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Country | US
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Telephone | 708-224-8321
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Fax |
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Provider Business Mailing Address
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Address Line | 7146 183RD ST STE 160
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City | TINLEY PARK
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State | IL
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Zip | 60477-3933
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Country | US
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Telephone | 773-669-5851
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 20043332B
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20043332A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.011228
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License Number State | IL
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