Provider Demographics
NPI:1356576870
Name:HASKIN, CHAUNTINA L
Entity type:Individual
Prefix:
First Name:CHAUNTINA
Middle Name:L
Last Name:HASKIN
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 1:4043 EUCLID LN.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471
Mailing Address - Country:US
Mailing Address - Phone:708-748-5700
Mailing Address - Fax:708-748-4245
Practice Address - Street 1:4043 EUCLID LN
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1310
Practice Address - Country:US
Practice Address - Phone:708-748-5700
Practice Address - Fax:708-748-4245
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist