Healthcare Provider Details

I. General information

NPI: 1528632197
Provider Name (Legal Business Name): DEBORAH CARTER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 STEVENSON DR
SPRINGFIELD IL
62703-4331
US

IV. Provider business mailing address

55 E JACKSON BLVD STE 1500
CHICAGO IL
60604-4184
US

V. Phone/Fax

Practice location:
  • Phone: 877-381-6538
  • Fax: 217-529-9151
Mailing address:
  • Phone: 312-663-1300
  • Fax: 312-663-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150009411
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: