Provider Demographics
NPI:1720570401
Name:FORD-SILLS, EVISHA
Entity Type:Individual
Prefix:DR
First Name:EVISHA
Middle Name:
Last Name:FORD-SILLS
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 1:2228 MACDONALD LN
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1340
Mailing Address - Country:US
Mailing Address - Phone:708-307-0440
Mailing Address - Fax:
Practice Address - Street 1:17512 E CARRIAGEWAY DR UNIT ABC
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2091
Practice Address - Country:US
Practice Address - Phone:708-798-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490113991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical