Healthcare Provider Details

I. General information

NPI: 1124879069
Provider Name (Legal Business Name): PRANVERA QENDRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 FOSTER ST
SKOKIE IL
60077-1371
US

IV. Provider business mailing address

4840 FOSTER ST APT 402
SKOKIE IL
60077-1361
US

V. Phone/Fax

Practice location:
  • Phone: 847-596-0982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.026395
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: