Provider Demographics
NPI:1215101274
Name:WEITZEL, DENISE ANN (LCSW)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:WEITZEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2001
Mailing Address - Country:US
Mailing Address - Phone:312-326-4472
Mailing Address - Fax:312-326-4396
Practice Address - Street 1:55 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2001
Practice Address - Country:US
Practice Address - Phone:312-326-4472
Practice Address - Fax:312-326-4396
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490107621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical