Iacono Russell, Georgeann L

Iacono Russell, Georgeann L is an individual health care provider with primary practice located at 7411 West Lake Street Building A, Suite L120, River Forest IL 60305-1876. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Iacono Russell, Georgeann L can be contacted via phone (708) 488-1919.

Contact Information

Primary practice address
7411 West Lake Street Building A, Suite L120 River Forest IL 60305-1876
Phone: (708) 488-1919
Fax: (708) 763-2120
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 071-004593 Illinois

Profile Details

NPI number 1164552154
LBN Legal business name Iacono Russell, Georgeann L
Credentials PH.D
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 7th, 2007
Last updated Mar 11th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164552154 NPPES
Illinois Other 21623162 BCBS GROUP NUMBER

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