Individual
BLAISE FAYOLLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
455 N CITYFRONT PLAZA DR, CHICAGO, IL 60611-5503
(312) 705-1503
Mailing address
1927 N HONORE ST APT 2B, CHICAGO, IL 60622-7560
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178.013787
IL
Other
Enumeration date
05/21/2018
Last updated
05/21/2018
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