Healthcare Provider Details

I. General information

NPI: 1073433140
Provider Name (Legal Business Name): DANA DAVIDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 LAUREL AVE
GLENVIEW IL
60025-1419
US

IV. Provider business mailing address

4722 LAUREL AVE
GLENVIEW IL
60025-1419
US

V. Phone/Fax

Practice location:
  • Phone: 773-504-4358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149010431
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: