Provider Demographics
NPI:1699344069
Name:OUTHMAN, BASMA (LSW)
Entity type:Individual
Prefix:
First Name:BASMA
Middle Name:
Last Name:OUTHMAN
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 1:1230 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4519
Mailing Address - Country:US
Mailing Address - Phone:630-966-4492
Mailing Address - Fax:
Practice Address - Street 1:1717 N NAPER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8838
Practice Address - Country:US
Practice Address - Phone:708-480-2048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.110170104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker