Provider Demographics
NPI:1659823391
Name:CHACON, DANIELA M
Entity Type:Individual
Prefix:MISS
First Name:DANIELA
Middle Name:M
Last Name:CHACON
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 1:8358 S KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3126
Mailing Address - Country:US
Mailing Address - Phone:708-612-1459
Mailing Address - Fax:
Practice Address - Street 1:8358 S KEELER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3126
Practice Address - Country:US
Practice Address - Phone:708-674-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician