Individual
JESSICA CHANDLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5910 W DIVISION ST, CHICAGO, IL 60651-1031
(773) 777-7112
Mailing address
5910 W DIVISION ST, CHICAGO, IL 60651-1031
(773) 777-7112
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2332532
—
IL
Enumeration date
01/18/2018
Last updated
01/18/2018
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