Provider Demographics
NPI:1912618489
Name:SPELLS, MONIQUE (LSW)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:SPELLS
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 1:4433 N RAVENSWOOD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7755
Mailing Address - Country:US
Mailing Address - Phone:773-876-8763
Mailing Address - Fax:872-315-3138
Practice Address - Street 1:4433 N RAVENSWOOD AVE STE 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7755
Practice Address - Country:US
Practice Address - Phone:773-876-8763
Practice Address - Fax:872-315-3138
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1085041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL150108504OtherLSW