Provider Demographics
NPI:1447077458
Name:HEARD, CHANTELL SHAMAR
Entity type:Individual
Prefix:
First Name:CHANTELL
Middle Name:SHAMAR
Last Name:HEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 S KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3603
Mailing Address - Country:US
Mailing Address - Phone:773-444-7046
Mailing Address - Fax:
Practice Address - Street 1:2923 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7886
Practice Address - Country:US
Practice Address - Phone:800-206-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker