Healthcare Provider Details

I. General information

NPI: 1558292896
Provider Name (Legal Business Name): IZAIAH WEBB LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 SYCAMORE RD
DEKALB IL
60115-2484
US

IV. Provider business mailing address

1211 SYCAMORE RD
DEKALB IL
60115-2484
US

V. Phone/Fax

Practice location:
  • Phone: 815-517-0825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022684
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: