Provider Demographics
NPI:1316086275
Name:WARD, DELORES P (MSRN)
Entity type:Individual
Prefix:
First Name:DELORES
Middle Name:P
Last Name:WARD
Suffix:
Gender:F
Credentials:MSRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N WEBSTER CIR E
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2754
Mailing Address - Country:US
Mailing Address - Phone:815-935-1286
Mailing Address - Fax:
Practice Address - Street 1:1905 W COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3163
Practice Address - Country:US
Practice Address - Phone:815-933-2240
Practice Address - Fax:815-935-7261
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health