Provider Demographics
NPI:1679818744
Name:WILLIS, ELIZABETH MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:KIOLBASA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:2323 NAPERVILLE RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3444
Mailing Address - Country:US
Mailing Address - Phone:331-457-5533
Mailing Address - Fax:331-457-5532
Practice Address - Street 1:2323 NAPERVILLE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3444
Practice Address - Country:US
Practice Address - Phone:331-457-5533
Practice Address - Fax:331-457-5532
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0148361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical