Healthcare Provider Details

I. General information

NPI: 1457418162
Provider Name (Legal Business Name): CONSTANCE YABLONSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 N AVONDALE AVE STE A101
CHICAGO IL
60631-1900
US

IV. Provider business mailing address

6038 N NEWBURG AVE
CHICAGO IL
60631-2602
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-7555
  • Fax: 773-774-8910
Mailing address:
  • Phone: 773-775-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: