Provider Demographics
NPI:1275014250
Name:FAYE, EDEN (MGCS, GC)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:FAYE
Suffix:
Gender:F
Credentials:MGCS, GC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N WABASH AVE APT 2006
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-7650
Mailing Address - Country:US
Mailing Address - Phone:248-762-1416
Mailing Address - Fax:
Practice Address - Street 1:1875 DEMPSTER ST STE 285
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1157
Practice Address - Country:US
Practice Address - Phone:847-723-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS