Individual
ROSE FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSADC - MISA 11
Contact information
Practice address
7124 W GRAND AVE, CHICAGO, IL 60707-2805
(773) 598-8540
(773) 569-3423
Mailing address
7124 W GRAND AVE, CHICAGO, IL 60707-2805
(773) 598-8540
(773) 569-3423
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18705
IL
Other
Enumeration date
03/16/2017
Last updated
03/16/2017
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