Healthcare Provider Details

I. General information

NPI: 1356269468
Provider Name (Legal Business Name): LILAH MIA ALKAISSI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAKE ST STE 110
OAK PARK IL
60301-1106
US

IV. Provider business mailing address

1010 LAKE ST STE 110
OAK PARK IL
60301-1106
US

V. Phone/Fax

Practice location:
  • Phone: 708-416-6475
  • Fax:
Mailing address:
  • Phone: 708-416-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.119338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: