Lacretia Brazzleton
Individual provider Active NPI Social Worker · Burnham, IL
NPI 1871004887 · NPPES record last updated May 9, 2025
Key facts
- NPI
- 1871004887
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 150107068 (IL)
- Practice address
- 14447 S Bensley Ave
Burnham, IL 60633-2224 - Phone
- (708) 862-0212
- NPI assigned
- Oct 17, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150107068 | IL | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grand Prairie Services | Past | Accepting new patients | |
| Grand Prairie Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Social Worker | 104100000X | 150107068 | IL | Yes |
Addresses
Primary practice location
14447 S Bensley Ave
Burnham, IL 60633-2224
Mailing address
17746 Oak Park Ave
Tinley Park, IL 60477-3936
Other providers in Burnham, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.