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General NPI Number Information
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NPI Number | 1578715165
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Entity Type | Individual
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Provider Name | KELLI ELIZABETH CANADA LCSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 2750 N. RACINE AVE.
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City | CHICAGO
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State | IL
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Zip | 60614
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Country | US
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Telephone | 773-529-1200
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Fax | 773-296-6131
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Provider Business Mailing Address
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Address Line | 225 N. RACINE AVE #3E
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City | CHICAGO
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State | IL
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Zip | 60607
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Country | US
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Telephone | 773-573-0846
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.011358
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License Number State | IL
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