Healthcare Provider Details

I. General information

NPI: 1508793845
Provider Name (Legal Business Name): IVAN DE ALBA ROMERO LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MICHIGAN AVE STE 500C
CHICAGO IL
60601-7511
US

IV. Provider business mailing address

155 N MICHIGAN AVE STE 500C
CHICAGO IL
60601-7511
US

V. Phone/Fax

Practice location:
  • Phone: 312-620-7551
  • Fax: 844-439-0608
Mailing address:
  • Phone: 312-620-7551
  • Fax: 844-439-0608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150118201
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: