Provider Demographics
NPI:1336957844
Name:SEEDER, DANIEL CHANCE
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHANCE
Last Name:SEEDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 N MONTICELLO AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5649
Mailing Address - Country:US
Mailing Address - Phone:773-577-6640
Mailing Address - Fax:
Practice Address - Street 1:5635 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4384
Practice Address - Country:US
Practice Address - Phone:773-736-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.113089104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker