Healthcare Provider Details

I. General information

NPI: 1831698547
Provider Name (Legal Business Name): MS. MARJORIE COLINDRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 01/01/2021
Certification Date: 01/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E BOUGHTON RD STE 265
BOLINGBROOK IL
60440-2396
US

IV. Provider business mailing address

9S070 LAKE DR
WILLOWBROOK IL
60527-2560
US

V. Phone/Fax

Practice location:
  • Phone: 331-318-8181
  • Fax: 630-863-7293
Mailing address:
  • Phone: 630-689-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.018025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: