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NPI Code Detail

MEDICARE: DEVEREUX HALL LCSW

MEDICARE:   DEVEREUX  HALL  LCSW
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
11041C0700XClinical Social Worker149023141IL

General Provider Information

NPI Number : 1801311139
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVEREUX HALL LCSW
Provider Business Mailing Address
First Line : 1466 FAIRWAY DR APT 101
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-9122
Country : US
Telephone Number : 773-569-0626
Fax Number :
Provider Business Practice Location Address
First Line : 750 OAKMONT LN
Second Line :
City : WESTMONT
State : IL
Zip : 60559-5551
Country : US
Telephone Number : 630-861-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2017
Last Update Date : 09/19/2022

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Directions to “ DEVEREUX HALL LCSW” Practice Location

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