Provider Demographics
NPI:1427414135
Name:DEBORAH'S PLACE
Entity Type:Organization
Organization Name:DEBORAH'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF STRATEGY OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOOTON WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-638-6392
Mailing Address - Street 1:1530 N SEDGWICK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5853
Mailing Address - Country:US
Mailing Address - Phone:312-944-9227
Mailing Address - Fax:312-944-1398
Practice Address - Street 1:2822 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3653
Practice Address - Country:US
Practice Address - Phone:773-722-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.007559251B00000X, 251S00000X
IL149.011208251B00000X, 251S00000X
IL149.016615251B00000X, 251S00000X
IL149,015965251B00000X
IL150.015350251B00000X, 251S00000X
IL149.015965251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management