Provider Demographics
NPI:1477684165
Name:SMITH, LOUISE C
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W MARGATE TER
Mailing Address - Street 2:APT. 1C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3824
Mailing Address - Country:US
Mailing Address - Phone:773-769-4579
Mailing Address - Fax:
Practice Address - Street 1:900 W MARGATE TER
Practice Address - Street 2:APT. 1C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3824
Practice Address - Country:US
Practice Address - Phone:773-769-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
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