Provider Demographics
NPI:1164697165
Name:CHRISTOPHER, DEVAN LYNN (MSW)
Entity Type:Individual
Prefix:MR
First Name:DEVAN
Middle Name:LYNN
Last Name:CHRISTOPHER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-3152
Mailing Address - Country:US
Mailing Address - Phone:618-713-3793
Mailing Address - Fax:
Practice Address - Street 1:600 S MECHANIC ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-3152
Practice Address - Country:US
Practice Address - Phone:618-713-3793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041S0200X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker