Provider Demographics
NPI:1578135927
Name:DAVIS, MIKAYLA JACQUELINE
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:JACQUELINE
Last Name:DAVIS
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 1:3130 N LAKE SHORE DR APT 1816
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4923
Mailing Address - Country:US
Mailing Address - Phone:616-821-8103
Mailing Address - Fax:
Practice Address - Street 1:625 N MICHIGAN AVE STE 2550
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3182
Practice Address - Country:US
Practice Address - Phone:312-640-7740
Practice Address - Fax:312-640-7736
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker