Healthcare Provider Details

I. General information

NPI: 1730213299
Provider Name (Legal Business Name): BESSIE SULTON AKUAMOAH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 E HYDE PARK BLVD
CHICAGO IL
60615-2834
US

IV. Provider business mailing address

1145 E HYDE PARK BLVD
CHICAGO IL
60615-2834
US

V. Phone/Fax

Practice location:
  • Phone: 773-370-7687
  • Fax: 773-363-0448
Mailing address:
  • Phone: 773-370-7687
  • Fax: 773-363-0448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.008286
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number149.008286
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: