Provider Demographics
NPI:1508278482
Name:HOLLAND, VANESSA CHEVON (AAHCC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:CHEVON
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:AAHCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 N PERIWINKLE WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4038
Mailing Address - Country:US
Mailing Address - Phone:847-219-7345
Mailing Address - Fax:
Practice Address - Street 1:2401 N PERIWINKLE WAY
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-4038
Practice Address - Country:US
Practice Address - Phone:847-219-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBRADLEY METHOD AAHCC174H00000X
ILBRADLEY DOULA, AAHCC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator