Healthcare Provider Details

I. General information

NPI: 1134886864
Provider Name (Legal Business Name): ILIANA E ESPINOSA- RAVI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
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: 773-514-8006
  • Fax:
Mailing address:
  • Phone: 773-514-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.023990
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: