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NPI Code Detail

MEDICARE: VANESSA ERICA FORD LCSW, CADC

MEDICARE: VANESSA ERICA FORD LCSW, CADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor22776IL
21041C0700XClinical Social Worker149009994IL

General Provider Information

NPI Number : 1184602427
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA ERICA FORD LCSW, CADC
Provider Business Mailing Address
First Line : 1155 W ROOSEVELT RD
Second Line : UNIT # 409
City : CHICAGO
State : IL
Zip : 60608-1671
Country : US
Telephone Number : 773-552-8070
Fax Number :
Provider Business Practice Location Address
First Line : 4003 N BROADWAY ST
Second Line : SUITE 6
City : CHICAGO
State : IL
Zip : 60613-2110
Country : US
Telephone Number : 773-552-8070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 08/13/2007

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