Individual ProviderDiandra EntlerSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1209 W Diversey Pkwy Unit G2, Chicago, IL 60614-1201(312) 725-4879PECOS EnrollmentBased on the most recent information from CMS, provider Diandra Entler does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1235803784Provider TypeIndividualFull NameEntler, DiandraCredentialMS, LCSW, CCLSGenderFemaleSole ProprietorYesEnumeration Date8/6/2021Last Updated8/6/2021Contact InformationPractice LocationPractice Address1209 W Diversey Pkwy Unit G2, Chicago, IL 60614-1201Phone(312) 725-4879FaxUnlisted FaxMailing LocationMailing Address1209 W Diversey Pkwy Unit G2, Chicago, IL 60614-1201Phone(312) 725-4879FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense149.023166IllinoisProvider IdentifiersIDDescriptionIssuerID149.023166DescriptionOtherIssuerLCSW LICENSEIllinois