Provider Demographics
NPI:1487436986
Name:SMITH, NATALIE DIANE (LCSW)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:DIANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 S NAPERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5805
Mailing Address - Country:US
Mailing Address - Phone:630-462-7005
Mailing Address - Fax:
Practice Address - Street 1:5205 N CHRISTIANA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4724
Practice Address - Country:US
Practice Address - Phone:773-524-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0128851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical