Healthcare Provider Details

I. General information

NPI: 1861889792
Provider Name (Legal Business Name): NANCY HEAP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E CHESTNUT ST
CHICAGO IL
60611-2014
US

IV. Provider business mailing address

4208 N CENTRAL PARK AVE
CHICAGO IL
60618-2020
US

V. Phone/Fax

Practice location:
  • Phone: 312-787-8425
  • Fax:
Mailing address:
  • Phone: 773-497-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149006930
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: