Healthcare Provider Details

I. General information

NPI: 1235033671
Provider Name (Legal Business Name): JERILYN M ARTHUR LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E HURON ST UNIT 4B
CHICAGO IL
60611-5244
US

IV. Provider business mailing address

1851 N HUMBOLDT BLVD APT 2
CHICAGO IL
60647-8164
US

V. Phone/Fax

Practice location:
  • Phone: 866-434-1735
  • Fax:
Mailing address:
  • Phone: 812-606-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.115903
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: