Provider Demographics
NPI:1376655464
Name:DEVRIES, JEFFREY BRIAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:DEVRIES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19646 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1333
Mailing Address - Country:US
Mailing Address - Phone:708-478-1933
Mailing Address - Fax:708-478-3089
Practice Address - Street 1:19646 WOLF RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1333
Practice Address - Country:US
Practice Address - Phone:708-478-1933
Practice Address - Fax:708-478-3089
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
366530Medicare ID - Type Unspecified