Healthcare Provider Details

I. General information

NPI: 1053843110
Provider Name (Legal Business Name): SENAIT GEBRETSADIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MAIN ST
ALGONQUIN IL
60102-2448
US

IV. Provider business mailing address

215 N MAIN ST
ALGONQUIN IL
60102-2448
US

V. Phone/Fax

Practice location:
  • Phone: 224-678-9033
  • Fax: 224-678-9493
Mailing address:
  • Phone: 224-678-9033
  • Fax: 224-678-9493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149018085
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: