Healthcare Provider Details

I. General information

NPI: 1376997379
Provider Name (Legal Business Name): MS. SACHIKO KAWATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4753 N BROADWAY ST SUITE #925
CHICAGO IL
60640-5266
US

IV. Provider business mailing address

4752 N BROADWAY ST #925
CHICAGO IL
60640-4909
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-2780
  • Fax:
Mailing address:
  • Phone: 773-989-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.018432
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: