Healthcare Provider Details

I. General information

NPI: 1740910025
Provider Name (Legal Business Name): ANGELA DEANINE LEE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 JORIE BLVD STE 360
OAK BROOK IL
60523-3040
US

IV. Provider business mailing address

1010 JORIE BLVD STE 360
OAK BROOK IL
60523-3040
US

V. Phone/Fax

Practice location:
  • Phone: 773-998-9948
  • Fax:
Mailing address:
  • Phone: 708-872-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027340
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: