Healthcare Provider Details

I. General information

NPI: 1134046188
Provider Name (Legal Business Name): ANAHI CHACON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 W 103RD ST STE 203
OAK LAWN IL
60453-4868
US

IV. Provider business mailing address

4550 W 103RD ST STE 203
OAK LAWN IL
60453-4868
US

V. Phone/Fax

Practice location:
  • Phone: 773-581-4357
  • Fax: 773-498-7186
Mailing address:
  • Phone: 773-581-4357
  • Fax: 773-498-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150111043
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: