Provider Demographics
NPI:1013316264
Name:WHITESIDE, IRMA (SOCIAL WORK)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:SOCIAL WORK
Other - Prefix:MRS
Other - First Name:IRMA
Other - Middle Name:
Other - Last Name:WHITESIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2213 GILBOA AVE
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-2240
Mailing Address - Country:US
Mailing Address - Phone:847-746-0564
Mailing Address - Fax:
Practice Address - Street 1:2213 GILBOA AVE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2240
Practice Address - Country:US
Practice Address - Phone:847-746-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker