Provider Demographics
NPI:1326654690
Name:DECOURCHELLE, HELENE (MT)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:
Last Name:DECOURCHELLE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:MRS
Other - First Name:HELENE
Other - Middle Name:
Other - Last Name:KEBABTCHIEFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3524 N MARSHFIELD AVE PH
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1248
Mailing Address - Country:US
Mailing Address - Phone:773-431-3132
Mailing Address - Fax:
Practice Address - Street 1:3524 N MARSHFIELD AVE PH
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1248
Practice Address - Country:US
Practice Address - Phone:773-431-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227021821225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11332081677OtherID