Healthcare Provider Details

I. General information

NPI: 1447873633
Provider Name (Legal Business Name): SUK MAN WONG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 11/27/2023
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 W CERMAK RD
CHICAGO IL
60608-4204
US

IV. Provider business mailing address

3027 S PRINCETON AVE APT 2
CHICAGO IL
60616-4626
US

V. Phone/Fax

Practice location:
  • Phone: 773-596-9045
  • Fax:
Mailing address:
  • Phone: 224-410-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009079
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: