1891036893 NPI number — MS. DEANNE LOIS DRECHSLER BAJAJ LCSW

Table of content: MS. DEANNE LOIS DRECHSLER BAJAJ LCSW (NPI 1891036893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891036893 NPI number — MS. DEANNE LOIS DRECHSLER BAJAJ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAJAJ
Provider First Name:
DEANNE
Provider Middle Name:
LOIS DRECHSLER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DRECHSLER
Provider Other First Name:
DEANNE
Provider Other Middle Name:
LOIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891036893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2604 RED ROCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAL
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61761-6438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-704-2585
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2422 E WASHINGTON ST STE 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61704-1611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-408-0202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149.015391 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com