Individual
AVIS RANDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
259 E 115TH ST, CHICAGO, IL 60628-5014
(313) 585-6084
Mailing address
259 E 115TH ST, CHICAGO, IL 60628-5014
(313) 585-6084
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
08/21/2016
Last updated
05/27/2025
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