Healthcare Provider Details

I. General information

NPI: 1992255319
Provider Name (Legal Business Name): ANTHONY WRIGHT MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 WEST OHIO STREET
CHICAGO IL
60654
US

IV. Provider business mailing address

7427 SOUTH CHICAGO AVE
CHICAGO IL
60619
US

V. Phone/Fax

Practice location:
  • Phone: 312-339-0726
  • Fax:
Mailing address:
  • Phone: 773-407-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: