Healthcare Provider Details

I. General information

NPI: 1780002048
Provider Name (Legal Business Name): VANESSA HOBSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

2623 NORWOOD DR
ROCKFORD IL
61107-1023
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-6842
  • Fax:
Mailing address:
  • Phone: 312-569-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149015744
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: