Provider Demographics
NPI:1104117795
Name:ABBOTT, LINDA (LSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7670 MARMORA AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2628
Mailing Address - Country:US
Mailing Address - Phone:847-967-1800
Mailing Address - Fax:847-470-8023
Practice Address - Street 1:7670 MARMORA AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2628
Practice Address - Country:US
Practice Address - Phone:847-967-1800
Practice Address - Fax:847-470-8023
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150011544104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker