MEDICARE: ABBEY DEDDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker		IL

General Provider Information

NPI Number	:	1063368603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBEY DEDDO

Provider Business Mailing Address
First Line	:	2220 N ILLINOIS AVE STE D
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-5647
Country	:	US
Telephone Number	:	708-340-9636
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 N DIVISION ST
Second Line	:
City	:	DU QUOIN
State	:	IL
Zip	:	62832-1723
Country	:	US
Telephone Number	:	618-542-5954
Fax Number	:	618-542-8592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ ABBEY DEDDO ” Practice Location

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