Provider Demographics
NPI:1588475438
Name:COSEY, CHANEL MULAN
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:MULAN
Last Name:COSEY
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 1:832 S AUSTIN BLVD APT 1G
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2329
Mailing Address - Country:US
Mailing Address - Phone:773-916-0878
Mailing Address - Fax:
Practice Address - Street 1:832 S AUSTIN BLVD APT 1G
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2329
Practice Address - Country:US
Practice Address - Phone:773-916-0878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician