Provider Demographics
NPI:1649722232
Name:STILLMAN, MINDY DENISE (LCSW, CCM)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:DENISE
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:LCSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 W OLIVE AVE
Mailing Address - Street 2:1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4123
Mailing Address - Country:US
Mailing Address - Phone:847-778-0419
Mailing Address - Fax:
Practice Address - Street 1:1636 W OLIVE AVE
Practice Address - Street 2:1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4123
Practice Address - Country:US
Practice Address - Phone:847-778-0419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0102271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical