Healthcare Provider Details

I. General information

NPI: 1629326483
Provider Name (Legal Business Name): ALYSON MINKUS LCSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/03/2024
Certification Date: 08/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CRAWFORD AVE STE 208
EVANSTON IL
60201-4959
US

IV. Provider business mailing address

256 AVON AVE
NORTHFIELD IL
60093-3209
US

V. Phone/Fax

Practice location:
  • Phone: 847-494-2472
  • Fax:
Mailing address:
  • Phone: 847-494-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30341
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149017301
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: