Provider Demographics
NPI:1730844887
Name:PRICE, DESEREE DAUN
Entity type:Individual
Prefix:
First Name:DESEREE
Middle Name:DAUN
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESEREE
Other - Middle Name:DAUN
Other - Last Name:STRANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:407 N BASIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-9639
Mailing Address - Country:US
Mailing Address - Phone:618-516-5326
Mailing Address - Fax:618-516-5325
Practice Address - Street 1:407 N BASIN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-9639
Practice Address - Country:US
Practice Address - Phone:618-516-5326
Practice Address - Fax:618-516-5325
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1349OtherEGYPTIAN HEALTH DEPARTMENT