Healthcare Provider Details

I. General information

NPI: 1881776516
Provider Name (Legal Business Name): JILL BEDERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N YORK ST
ELMHURST IL
60126-2717
US

IV. Provider business mailing address

711 N RIDGELAND AVE
OAK PARK IL
60302-1735
US

V. Phone/Fax

Practice location:
  • Phone: 630-833-1353
  • Fax: 630-833-8767
Mailing address:
  • Phone: 708-848-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: