Healthcare Provider Details

I. General information

NPI: 1225892904
Provider Name (Legal Business Name): LINDSEY N WATTS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 W 115TH ST
CHICAGO IL
60655-3642
US

IV. Provider business mailing address

3536 W 115TH ST
CHICAGO IL
60655-3642
US

V. Phone/Fax

Practice location:
  • Phone: 773-675-0306
  • Fax:
Mailing address:
  • Phone: 773-675-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number150112874
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: