Healthcare Provider Details

I. General information

NPI: 1609448935
Provider Name (Legal Business Name): KIZAWANDA AFIA OLOWE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KIZAWANDA AFIA MAGGETTE

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 06/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6209 S UNIVERSITY AVE APT 1N
CHICAGO IL
60637-2769
US

IV. Provider business mailing address

6209 S UNIVERSITY AVE APT 1N
CHICAGO IL
60637-2769
US

V. Phone/Fax

Practice location:
  • Phone: 773-430-8391
  • Fax:
Mailing address:
  • Phone: 773-430-8391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149015318
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: