Healthcare Provider Details

I. General information

NPI: 1982994133
Provider Name (Legal Business Name): NANCY EASTON STEVENSON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5348 N SPAULDING AVE
CHICAGO IL
60625-4722
US

IV. Provider business mailing address

5348 N SPAULDING AVE
CHICAGO IL
60625-4722
US

V. Phone/Fax

Practice location:
  • Phone: 773-588-1825
  • Fax:
Mailing address:
  • Phone: 773-588-1825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.012622
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: