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General NPI Number Information
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NPI Number | 1689188633
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Entity Type | Individual
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Provider Name | DEVETA KAMIL GELISPIE LSW
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Gender | Female
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 5000 S 5TH AVE BLDG 2284TH
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City | HINES
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State | IL
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Zip | 60141-3030
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Country | US
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Telephone | 708-202-4952
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Fax |
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Provider Business Mailing Address
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Address Line | 4853 S VINCENNES AVE UNIT 305
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City | CHICAGO
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State | IL
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Zip | 60615-1478
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Country | US
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Telephone | 312-890-4205
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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 | 150101980
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License Number State | IL
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