Healthcare Provider Details

I. General information

NPI: 1609212877
Provider Name (Legal Business Name): SENECA STEVENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 ROOSEVELT RD
FOREST PARK IL
60130-2500
US

IV. Provider business mailing address

3705 W 77TH ST
CHICAGO IL
60652-1332
US

V. Phone/Fax

Practice location:
  • Phone: 708-771-7000
  • Fax:
Mailing address:
  • Phone: 708-417-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149021503
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: