Healthcare Provider Details

I. General information

NPI: 1952135741
Provider Name (Legal Business Name): GENEROSA ISABEL RODRIGUEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 N KOSTNER AVE
CHICAGO IL
60641-5348
US

IV. Provider business mailing address

2949 N KOSTNER AVE
CHICAGO IL
60641-5348
US

V. Phone/Fax

Practice location:
  • Phone: 773-240-7491
  • Fax:
Mailing address:
  • Phone: 773-240-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.020318
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: