Individual
DE'JUAN ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2310 W ROOSEVELT RD, CHICAGO, IL 60608-1131
(312) 566-4500
Mailing address
3604 CANAL ST, NEW ORLEANS, LA 70119-6111
(504) 822-4333
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
362170821
IL
101Y00000X
Counselor
—
LA
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Enumeration date
09/18/2015
Last updated
05/11/2018
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