Healthcare Provider Details

I. General information

NPI: 1588572440
Provider Name (Legal Business Name): VICTOR E RODRIGUEZ LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 W 111TH ST STE 107
CHICAGO IL
60655-4028
US

IV. Provider business mailing address

3838 W 111TH ST STE 107
CHICAGO IL
60655-4028
US

V. Phone/Fax

Practice location:
  • Phone: 773-270-0443
  • Fax:
Mailing address:
  • Phone: 773-270-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150119041
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: