Provider Demographics
NPI:1518581982
Name:WILLIAMS, ILSZA
Entity Type:Individual
Prefix:
First Name:ILSZA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ILSZA
Other - Middle Name:
Other - Last Name:HEREDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 RAVINE WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7615
Mailing Address - Country:US
Mailing Address - Phone:847-730-3042
Mailing Address - Fax:
Practice Address - Street 1:2400 RAVINE WAY STE 600
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7615
Practice Address - Country:US
Practice Address - Phone:847-730-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty