Provider Demographics
NPI:1720088388
Name:SILLER, DONNA R (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:SILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 N PLUM GROVE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4760
Mailing Address - Country:US
Mailing Address - Phone:847-413-9700
Mailing Address - Fax:847-413-9700
Practice Address - Street 1:919 N PLUM GROVE RD STE C
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4760
Practice Address - Country:US
Practice Address - Phone:847-413-9700
Practice Address - Fax:847-413-9700
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040013211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008919232Medicaid
VA0904001321OtherLIC
VA0904001321OtherLIC
VA008919232Medicaid