Healthcare Provider Details

I. General information

NPI: 1467379131
Provider Name (Legal Business Name): VICTORIA DAVIS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST STE 1835
CHICAGO IL
60602-1836
US

IV. Provider business mailing address

25 E WASHINGTON ST STE 1835
CHICAGO IL
60602-1836
US

V. Phone/Fax

Practice location:
  • Phone: 312-940-3655
  • Fax:
Mailing address:
  • Phone: 312-940-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.129437
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: