Provider Demographics
NPI:1497402804
Name:LEDEZMA, KAREN JEANETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JEANETTE
Last Name:LEDEZMA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6551 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1020
Mailing Address - Country:US
Mailing Address - Phone:224-442-4914
Mailing Address - Fax:
Practice Address - Street 1:6551 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1020
Practice Address - Country:US
Practice Address - Phone:224-442-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0241091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical