Provider Demographics
NPI:1972918258
Name:GREEN, RIKKELL (MSW)
Entity type:Individual
Prefix:MS
First Name:RIKKELL
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W FARWELL AVE
Mailing Address - Street 2:APT. 3A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3141
Mailing Address - Country:US
Mailing Address - Phone:773-234-3316
Mailing Address - Fax:
Practice Address - Street 1:1800 W FARWELL AVE
Practice Address - Street 2:APT. 3A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-3141
Practice Address - Country:US
Practice Address - Phone:773-234-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22889921041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool