Healthcare Provider Details

I. General information

NPI: 1942012786
Provider Name (Legal Business Name): SIMRAN RATHOD LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 W MADISON ST STE 302
CHICAGO IL
60607-2191
US

IV. Provider business mailing address

627 BREAKERS PT
SCHAUMBURG IL
60194-3605
US

V. Phone/Fax

Practice location:
  • Phone: 312-324-4502
  • Fax:
Mailing address:
  • Phone: 630-461-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.115957
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: