Individual
KELLY RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1409 W CARROLL AVE, CHICAGO, IL 60607-1105
(312) 733-0883
Mailing address
1409 W CARROLL AVE, CHICAGO, IL 60607-1105
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.111855
IL
1041S0200X
School Social Worker
2331484
IL
Other
Enumeration date
07/19/2022
Last updated
10/13/2023
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