Healthcare Provider Details

I. General information

NPI: 1477521292
Provider Name (Legal Business Name): ARRYN HAWTHORNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5756 N RIDGE AVE STE 15
CHICAGO IL
60660-5333
US

IV. Provider business mailing address

5756 N RIDGE AVE STE 15
CHICAGO IL
60660-5333
US

V. Phone/Fax

Practice location:
  • Phone: 773-688-4499
  • Fax:
Mailing address:
  • Phone: 773-688-4499
  • Fax: 773-813-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009565
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: