Provider Demographics
NPI:1942666003
Name:OLLIE, AYESHA (LSW)
Entity type:Individual
Prefix:MS
First Name:AYESHA
Middle Name:
Last Name:OLLIE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E 50TH PL
Mailing Address - Street 2:73
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2328
Mailing Address - Country:US
Mailing Address - Phone:773-629-5048
Mailing Address - Fax:
Practice Address - Street 1:407 E 50TH PL
Practice Address - Street 2:73
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2328
Practice Address - Country:US
Practice Address - Phone:773-629-5048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.012014104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker