Healthcare Provider Details

I. General information

NPI: 1518909589
Provider Name (Legal Business Name): EILEEN M COLLISON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDW HINES VA HOSPITAL, MENTAL HEALTH CLINIC #116
HINES IL
60141
US

IV. Provider business mailing address

EDW HINES VA HOSPITAL, P.O. BOX 5000 #116
HINES IL
60141
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2109
  • Fax: 708-202-2108
Mailing address:
  • Phone: 708-202-2109
  • Fax: 708-202-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: