Healthcare Provider Details

I. General information

NPI: 1841562337
Provider Name (Legal Business Name): DEIRDRE ANN EKHOLDT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CENTRAL AVENUE
HIGHLAND PARK IL
60035
US

IV. Provider business mailing address

44 CHARCOAL HILL RD
WESTPORT CT
06880-1636
US

V. Phone/Fax

Practice location:
  • Phone: 847-432-4981
  • Fax:
Mailing address:
  • Phone: 224-300-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149008252
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number009064
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: