Healthcare Provider Details

I. General information

NPI: 1366364838
Provider Name (Legal Business Name): KEISHA GREEN LSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 DOUGLAS RD
OSWEGO IL
60543-5133
US

IV. Provider business mailing address

4981 MEADOW LAKE DR
RICHTON PARK IL
60471-1188
US

V. Phone/Fax

Practice location:
  • Phone: 630-898-5322
  • Fax:
Mailing address:
  • Phone: 630-898-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.112966
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: