Healthcare Provider Details

I. General information

NPI: 1700744794
Provider Name (Legal Business Name): ALEXANDRA WHITE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 N LINCOLN AVE STE G
CHICAGO IL
60657-8073
US

IV. Provider business mailing address

610 INVERNESS DR
AURORA IL
60504-5272
US

V. Phone/Fax

Practice location:
  • Phone: 312-809-0208
  • Fax:
Mailing address:
  • Phone: 630-881-6926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.022792
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: