Healthcare Provider Details

I. General information

NPI: 1790616878
Provider Name (Legal Business Name): ADRIANNA BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 167TH ST
TINLEY PARK IL
60477-2501
US

IV. Provider business mailing address

6811 167TH ST
TINLEY PARK IL
60477-2501
US

V. Phone/Fax

Practice location:
  • Phone: 773-295-6322
  • Fax: 773-596-3341
Mailing address:
  • Phone: 773-295-6322
  • Fax: 773-596-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: