Healthcare Provider Details

I. General information

NPI: 1811674310
Provider Name (Legal Business Name): SIAMIRELIS NAMBO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WINDSOR DR STE 111
OAK BROOK IL
60523-4081
US

IV. Provider business mailing address

125 WINDSOR DR STE 113
OAK BROOK IL
60523-4082
US

V. Phone/Fax

Practice location:
  • Phone: 163-072-8174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.029450
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150111732
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: