Healthcare Provider Details

I. General information

NPI: 1215848239
Provider Name (Legal Business Name): MS. LILLY CAMILLE SMALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 DUNDEE RD STE 101
NORTHBROOK IL
60062-2424
US

IV. Provider business mailing address

3000 DUNDEE RD STE 101
NORTHBROOK IL
60062-2424
US

V. Phone/Fax

Practice location:
  • Phone: 847-400-0078
  • Fax:
Mailing address:
  • Phone: 847-400-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.129305
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: