Healthcare Provider Details

I. General information

NPI: 1750777991
Provider Name (Legal Business Name): SHIRLEY HAWKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MAIN ST STE 210
ANTIOCH IL
60002-1578
US

IV. Provider business mailing address

707 E 47TH ST
CHICAGO IL
60653-4201
US

V. Phone/Fax

Practice location:
  • Phone: 847-903-5604
  • Fax:
Mailing address:
  • Phone: 312-949-5500
  • Fax: 773-538-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149018103
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: