Healthcare Provider Details

I. General information

NPI: 1043908791
Provider Name (Legal Business Name): KEELEY LAWRIW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N NORTHWEST HWY STE B4
PARK RIDGE IL
60068-3272
US

IV. Provider business mailing address

6219 W PETERSON AVE
CHICAGO IL
60646-4602
US

V. Phone/Fax

Practice location:
  • Phone: 773-339-5693
  • Fax:
Mailing address:
  • Phone: 773-339-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149016244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: