Provider Demographics
NPI:1831846682
Name:STALLWORTH, DELORTH (LSW)
Entity type:Individual
Prefix:MS
First Name:DELORTH
Middle Name:
Last Name:STALLWORTH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7509
Mailing Address - Country:US
Mailing Address - Phone:708-676-2817
Mailing Address - Fax:
Practice Address - Street 1:1 E ERIE ST STE 520
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2792
Practice Address - Country:US
Practice Address - Phone:312-761-4726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.106447104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker