Healthcare Provider Details

I. General information

NPI: 1366373557
Provider Name (Legal Business Name): ON THE VERGE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W BERWYN AVE
CHICAGO IL
60625-1119
US

IV. Provider business mailing address

2200 W BERWYN AVE
CHICAGO IL
60625-1119
US

V. Phone/Fax

Practice location:
  • Phone: 312-967-9848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ILLINGWORTH
Title or Position: OWNER
Credential: LCSW
Phone: 312-967-9848