Provider Demographics
NPI:1790431153
Name:LAM, WINNIE
Entity type:Individual
Prefix:
First Name:WINNIE
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 S TAN CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1998
Mailing Address - Country:US
Mailing Address - Phone:312-791-0418
Mailing Address - Fax:866-513-8246
Practice Address - Street 1:2141 S TAN CT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1998
Practice Address - Country:US
Practice Address - Phone:312-791-0418
Practice Address - Fax:312-815-7302
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490238701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362984043001Medicaid
IL362984043922Medicaid
IL362984043912Medicaid