Healthcare Provider Details

I. General information

NPI: 1104705508
Provider Name (Legal Business Name): SELAM ZEWDIE BEDADA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143000 RAVINIA AVE SUITE 100
ORLAND PARK IL
60462
US

IV. Provider business mailing address

7250 N CLAREMONT AVE
CHICAGO IL
60645-1804
US

V. Phone/Fax

Practice location:
  • Phone: 708-778-3779
  • Fax:
Mailing address:
  • Phone: 702-265-7597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209031849
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: