MEDICARE: ANGIE ARREOLA-OMALLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	166001320	IL

General Provider Information

NPI Number	:	1104296698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE ARREOLA-OMALLEY

Provider Business Mailing Address
First Line	:	811 N ROCKWELL ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5497
Country	:	US
Telephone Number	:	847-899-0295
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 W WILSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5318
Country	:	US
Telephone Number	:	872-249-9421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	01/24/2025

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Directions to “ ANGIE ARREOLA-OMALLEY ” Practice Location

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