Healthcare Provider Details

I. General information

NPI: 1518653237
Provider Name (Legal Business Name): TIFFANY ALEXANDER WHITEHORN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 PARK ST STE 200
NAPERVILLE IL
60563-8404
US

IV. Provider business mailing address

1755 PARK ST STE 200
NAPERVILLE IL
60563-8404
US

V. Phone/Fax

Practice location:
  • Phone: 630-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150108914
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: