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Individual

ELIZABETH DEITEMYER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2501 CHATHAM RD, SPRINGFIELD, IL 62704-4188
(312) 529-0679
Mailing address
2555 W CATALPA AVE APT 1C, CHICAGO, IL 60625-6708
(630) 863-2116

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.026162
IL
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
08/17/2019
Last updated
03/27/2024
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