Provider Demographics
NPI:1790375954
Name:VILLA, ISABELLA (LSW)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ISABELLA
Other - Middle Name:
Other - Last Name:VILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:1000 W DIVERSEY PKWY STE 275
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1879
Mailing Address - Country:US
Mailing Address - Phone:773-281-7200
Mailing Address - Fax:
Practice Address - Street 1:1000 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1879
Practice Address - Country:US
Practice Address - Phone:773-281-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.104855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty