Healthcare Provider Details

I. General information

NPI: 1871829630
Provider Name (Legal Business Name): JOHN R WINTON ACSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9718 S HALSTED ST
CHICAGO IL
60628-1007
US

IV. Provider business mailing address

9718 S HALSTED ST
CHICAGO IL
60628-1007
US

V. Phone/Fax

Practice location:
  • Phone: 773-298-2056
  • Fax: 773-233-4055
Mailing address:
  • Phone: 773-298-2056
  • Fax: 773-233-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149005804
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: