Provider Demographics
NPI:1154077477
Name:ABDALLA, OZAZ H
Entity Type:Individual
Prefix:
First Name:OZAZ
Middle Name:H
Last Name:ABDALLA
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 1:5500 W LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3513
Mailing Address - Country:US
Mailing Address - Phone:224-303-6341
Mailing Address - Fax:
Practice Address - Street 1:622 DAVIS ST STE 200
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4491
Practice Address - Country:US
Practice Address - Phone:773-294-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health