Provider Demographics
NPI:1417184581
Name:WARD-ILLICH, MICHELE RENEE (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENEE
Last Name:WARD-ILLICH
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:RENEE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:520 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2723
Mailing Address - Country:US
Mailing Address - Phone:610-430-6572
Mailing Address - Fax:
Practice Address - Street 1:1140 MCDERMOTT DR
Practice Address - Street 2:SUITE 100-101
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4043
Practice Address - Country:US
Practice Address - Phone:610-430-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker