Provider Demographics
NPI:1609640903
Name:LAWS, MERCEDES ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:ALEXANDRIA
Last Name:LAWS
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 1:691 N BRIDGE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1177
Mailing Address - Country:US
Mailing Address - Phone:815-242-2142
Mailing Address - Fax:
Practice Address - Street 1:691 N BRIDGE ST STE 200
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1177
Practice Address - Country:US
Practice Address - Phone:630-229-5139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.112036104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker