Organization
ALZA GREAT LAKES PSYCHOTHERAPY PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ENA ISIS MILLLWARD (LCSW)
(773) 707-6093
Entity
Organization
Contact information
Practice address
1719 N RUTHERFORD AVE, CHICAGO, IL 60707-3942
(708) 824-7533
(312) 748-4256
Mailing address
7061 NORTH AVE # 292, OAK PARK, IL 60302-1015
(708) 824-7533
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/30/2024
Last updated
02/12/2025
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