Healthcare Provider Details

I. General information

NPI: 1124744016
Provider Name (Legal Business Name): EMILY A HARTUNG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W BRADLEY PL
CHICAGO IL
60618-4716
US

IV. Provider business mailing address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

V. Phone/Fax

Practice location:
  • Phone: 877-552-6672
  • Fax: 224-306-1878
Mailing address:
  • Phone: 243-061-8792
  • Fax: 224-306-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.024602
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: