| NPI | 1982961603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE LEWIS FORD Practice Owner 312-399-3077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149011528) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2019-10-02 |