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General NPI Number Information
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NPI Number | 1871362012
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Entity Type | Individual
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Provider Name | GINA NIAGARA CRAIG
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Gender | Female
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Dates
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Enumeration Date | 12/29/2023
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 230 E OHIO ST STE 4101179
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City | CHICAGO
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State | IL
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Zip | 60611-3265
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Country | US
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Telephone | 855-577-3733
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Fax |
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Provider Business Mailing Address
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Address Line | 230 E OHIO ST STE 4101179
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City | CHICAGO
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State | IL
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Zip | 60611-3265
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Country | US
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Telephone | 855-577-3733
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | IL
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