Provider Demographics
NPI:1932347663
Name:SALLEY, EUNICE D (CNA AND PA)
Entity Type:Individual
Prefix:MS
First Name:EUNICE
Middle Name:D
Last Name:SALLEY
Suffix:
Gender:F
Credentials:CNA AND PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 S DAUPHIN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7723
Mailing Address - Country:US
Mailing Address - Phone:312-576-7127
Mailing Address - Fax:773-874-0131
Practice Address - Street 1:9220 S DAUPHIN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7723
Practice Address - Country:US
Practice Address - Phone:312-576-7127
Practice Address - Fax:773-874-0131
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor