Provider Demographics
NPI:1104847698
Name:BENTLEY, ESTELA (LCSW)
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:
Last Name:BENTLEY
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 1:15330 S LA GRANGE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3885
Mailing Address - Country:US
Mailing Address - Phone:708-516-9930
Mailing Address - Fax:
Practice Address - Street 1:15330 S LA GRANGE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3885
Practice Address - Country:US
Practice Address - Phone:708-516-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490106231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical