Healthcare Provider Details

I. General information

NPI: 1043793292
Provider Name (Legal Business Name): CURTIS D OSBORNE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W LINCOLN AVE
CASEYVILLE IL
62232-1329
US

IV. Provider business mailing address

3204 EAGLE WAY
CHICAGO IL
60678-1032
US

V. Phone/Fax

Practice location:
  • Phone: 618-345-3970
  • Fax: 618-345-4398
Mailing address:
  • Phone: 630-717-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.018314
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: