Individual
DAMO ANTWINE-JELANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NCSP
Contact information
Practice address
2650 W 35TH AVE, GARY, IN 46408-1416
(630) 864-0704
Mailing address
429 N WEBER RD STE B-274, ROMEOVILLE, IL 60446-3902
(630) 864-0704
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
10307188
IN
103TS0200X
School Psychologist
Primary
1185755
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1185755
—
IL
05
—
6099042
—
IL
05
—
63445
—
AZ
Enumeration date
10/25/2021
Last updated
03/07/2025
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