Healthcare Provider Details

I. General information

NPI: 1114438694
Provider Name (Legal Business Name): MICHELLE ESPINOSA LSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 E ALGONQUIN RD STE 401
SCHAUMBURG IL
60173-4159
US

IV. Provider business mailing address

1959 W CULLOM AVE
CHICAGO IL
60613-1054
US

V. Phone/Fax

Practice location:
  • Phone: 847-750-6019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.102723
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: