Provider Demographics
NPI:1043386212
Name:SPEER, DEBRA M (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:SPEER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 CENTRAL ST.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-475-5940
Mailing Address - Fax:847-475-5940
Practice Address - Street 1:2733 CENTRAL ST
Practice Address - Street 2:SUITE 3
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1219
Practice Address - Country:US
Practice Address - Phone:847-475-5940
Practice Address - Fax:847-475-5940
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490086431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P13414Medicare UPIN