Provider Demographics
NPI:1316344781
Name:PALL, MAUREEN (MSW, LSW)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:PALL
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 OGDEN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2894
Mailing Address - Country:US
Mailing Address - Phone:630-810-1200
Mailing Address - Fax:
Practice Address - Street 1:1048 OGDEN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2894
Practice Address - Country:US
Practice Address - Phone:630-810-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150014310104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker