Basic Information
Provider Information
NPI: 1952903320
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OWENS
FirstName: FRANSHANDRA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: LIDDELL
OtherFirstName: FRANSHANDRA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 3428
Address2:  
City: SPRINGFIELD
State: IL
PostalCode: 627083428
CountryCode: US
TelephoneNumber: 8005775368
FaxNumber: 2177577550
Practice Location
Address1: 710 N 8TH ST
Address2:  
City: SPRINGFIELD
State: IL
PostalCode: 627026324
CountryCode: US
TelephoneNumber: 2175251064
FaxNumber: 2175251651
Other Information
ProviderEnumerationDate: 11/11/2020
LastUpdateDate: 11/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X149022657ILY Behavioral Health & Social Service ProvidersSocial WorkerClinical

ID Information
IDTypeStateIssuerDescription
14902265701ILLCSW LICENSEOTHER


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