Healthcare Provider Details

I. General information

NPI: 1023651049
Provider Name (Legal Business Name): URBANSTREETZ THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 09/17/2022
Certification Date: 09/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9204 S COMMERCIAL AVE STE 206
CHICAGO IL
60617-2197
US

IV. Provider business mailing address

8364 S KENWOOD AVE
CHICAGO IL
60619-6437
US

V. Phone/Fax

Practice location:
  • Phone: 773-703-8486
  • Fax: 773-530-7588
Mailing address:
  • Phone: 773-703-8486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA M BURNETTE
Title or Position: LCSW/OWNER
Credential: LCSW
Phone: 773-703-8486