Individual
EALA O'SE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5215 N CALIFORNIA AVE STE F101, CHICAGO, IL 60625-0035
(773) 561-5809
Mailing address
6544 N ASHLAND AVE APT 3S, CHICAGO, IL 60626-6679
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/03/2024
Last updated
10/03/2024
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