Healthcare Provider Details

I. General information

NPI: 1831627959
Provider Name (Legal Business Name): RUAA SAFIA JABER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10537 S ROBERTS RD
PALOS HILLS IL
60465-1933
US

IV. Provider business mailing address

10316 MASON AVE APT. 2W
OAK LAWN IL
60453-5954
US

V. Phone/Fax

Practice location:
  • Phone: 708-974-5100
  • Fax:
Mailing address:
  • Phone: 708-645-6215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149019049
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: