Provider Demographics
NPI:1558094169
Name:EMANUEL, CHESERIE (QMHP)
Entity Type:Individual
Prefix:PROF
First Name:CHESERIE
Middle Name:
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:MS
Other - First Name:CHESERIE
Other - Middle Name:
Other - Last Name:EMANUEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QMHP
Mailing Address - Street 1:211 S CLARK ST UNIT 2350
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60690-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4950 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3118
Practice Address - Country:US
Practice Address - Phone:312-841-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL263994320001Medicaid