Provider Demographics
NPI:1073242996
Name:WASHINGTON, CHANEL (FULL SPECTRUM DOULA)
Entity Type:Individual
Prefix:MS
First Name:CHANEL
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:FULL SPECTRUM DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 MEACHAM RD # 1058
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3023
Mailing Address - Country:US
Mailing Address - Phone:312-804-9086
Mailing Address - Fax:
Practice Address - Street 1:927 N LOCKWOOD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651
Practice Address - Country:US
Practice Address - Phone:312-804-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula