Provider Demographics
NPI:1881776516
Name:BEDERMAN, JILL (LCSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:BEDERMAN
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 1:711 N RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1735
Mailing Address - Country:US
Mailing Address - Phone:708-848-4148
Mailing Address - Fax:
Practice Address - Street 1:209 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2717
Practice Address - Country:US
Practice Address - Phone:630-833-1353
Practice Address - Fax:630-833-8767
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK14170Medicare PIN