Individual
DIANDRA ENTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LCSW, CCLS
Contact information
Practice address
1209 W DIVERSEY PKWY UNIT G2, CHICAGO, IL 60614-1201
(312) 725-4879
Mailing address
1209 W DIVERSEY PKWY UNIT G2, CHICAGO, IL 60614-1201
(312) 725-4879
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.023166
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149.023166
LCSW LICENSE
IL
Enumeration date
08/06/2021
Last updated
08/06/2021
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