Provider Demographics
NPI:1699838110
Name:DEAN, DIANE CHRISTA (MSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:CHRISTA
Last Name:DEAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S EDGEWOOD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2151
Mailing Address - Country:US
Mailing Address - Phone:708-354-4251
Mailing Address - Fax:708-354-4251
Practice Address - Street 1:307 N MICHIGAN AVE
Practice Address - Street 2:STE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-357-0735
Practice Address - Fax:708-354-4251
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1L1490005341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical