Healthcare Provider Details

I. General information

NPI: 1639414519
Provider Name (Legal Business Name): DANA PLOUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. DANA PLOUS

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 W PETERSON AVE
CHICAGO IL
60646-5712
US

IV. Provider business mailing address

2331 N LISTER AVE UNIT F
CHICAGO IL
60614-2965
US

V. Phone/Fax

Practice location:
  • Phone: 312-545-9212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149013047
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: