Healthcare Provider Details

I. General information

NPI: 1033797493
Provider Name (Legal Business Name): DONELL BLUFORD JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W 127TH ST STE 325
PLAINFIELD IL
60585-9507
US

IV. Provider business mailing address

24600 W 127TH ST BLDG B
PLAINFIELD IL
60585-9509
US

V. Phone/Fax

Practice location:
  • Phone: 630-291-0155
  • Fax:
Mailing address:
  • Phone: 630-291-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.023021
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: