Healthcare Provider Details

I. General information

NPI: 1669299848
Provider Name (Legal Business Name): MLADENKA KOVACEVIC TOTONCHI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MLADENKA KOVACEVIC

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 S. MARTIN LUTHER KING JR DR
CHICAGO IL
60616
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 312-842-7117
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027149
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: