Healthcare Provider Details

I. General information

NPI: 1922997949
Provider Name (Legal Business Name): JORDAN HUSTON LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 N FRANCISCO AVE. GARDEN PAVILION-NEUROSCIENCES INSTITUTE
CHICAGO IL
60625-3611
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-2225
  • Fax: 773-989-4471
Mailing address:
  • Phone: 847-570-2570
  • Fax: 847-933-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149029582
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: