Provider Demographics
NPI:1598853541
Name:DEVONSHIRE, ROSALIE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:
Last Name:DEVONSHIRE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 LUTHER LN
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1243
Mailing Address - Country:US
Mailing Address - Phone:847-795-3100
Mailing Address - Fax:
Practice Address - Street 1:4322 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2144
Practice Address - Country:US
Practice Address - Phone:773-604-5321
Practice Address - Fax:773-604-5231
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK35719Medicare ID - Type UnspecifiedMEDICARE NUMBER