Healthcare Provider Details

I. General information

NPI: 1871857615
Provider Name (Legal Business Name): INDIVIDUAL AND FAMILY CONNECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 N DAMEN AVE
CHICAGO IL
60647-5511
US

IV. Provider business mailing address

1806 N DAMEN AVE
CHICAGO IL
60647-5511
US

V. Phone/Fax

Practice location:
  • Phone: 773-270-0469
  • Fax:
Mailing address:
  • Phone: 773-270-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIANNE C NEELY
Title or Position: THERAPIST, OWNER
Credential: MSW, LCSW
Phone: 773-270-0469