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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164552154 | NPPES |
| Illinois | Other | 21623162 | BCBS GROUP NUMBER |
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