Healthcare Provider Details

I. General information

NPI: 1134725799
Provider Name (Legal Business Name): JORDAN LEE WHEALDON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 N OGDEN AVE # 274
CHICAGO IL
60642-6421
US

IV. Provider business mailing address

516 N OGDEN AVE # 274
CHICAGO IL
60642-6421
US

V. Phone/Fax

Practice location:
  • Phone: 312-725-3099
  • Fax:
Mailing address:
  • Phone: 312-725-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149025347
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: