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General NPI Number Information
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NPI Number | 1366364838
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Entity Type | Individual
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Provider Name | KEISHA GREEN LSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 1022 DOUGLAS RD
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City | OSWEGO
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State | IL
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Zip | 60543-5133
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Country | US
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Telephone | 630-898-5322
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Fax |
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Provider Business Mailing Address
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Address Line | 4981 MEADOW LAKE DR
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City | RICHTON PARK
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State | IL
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Zip | 60471-1188
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Country | US
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Telephone | 630-898-5322
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.112966
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License Number State | IL
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