Provider Demographics
NPI:1013923564
Name:PARKER, LINDA DIANE (MS, MSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:DIANE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W ROOSEVELT RD
Mailing Address - Street 2:SUITE 10-B
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5068
Mailing Address - Country:US
Mailing Address - Phone:630-690-4150
Mailing Address - Fax:630-665-6175
Practice Address - Street 1:316 W ROOSEVELT RD
Practice Address - Street 2:SUITE 10-B
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5068
Practice Address - Country:US
Practice Address - Phone:630-690-4150
Practice Address - Fax:630-665-6175
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12895101YA0400X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL120816OtherCOMPSYCH
IL02271377OtherBLUE CROSS BLUE SHIELD
IL88288OtherMHN
IL4276386OtherAETNA
IL02271377OtherBLUE CROSS BLUE SHIELD