Healthcare Provider Details

I. General information

NPI: 1043865132
Provider Name (Legal Business Name): ALEXIS ANYA GOLDEN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S WACKER DR STE 2400
CHICAGO IL
60606-4211
US

IV. Provider business mailing address

9444 LOWELL AVE
SKOKIE IL
60076-1455
US

V. Phone/Fax

Practice location:
  • Phone: 847-293-3296
  • Fax:
Mailing address:
  • Phone: 847-293-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149041108
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: