Healthcare Provider Details

I. General information

NPI: 1427969351
Provider Name (Legal Business Name): SOPHIE TROY LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 OLD GLENVIEW RD STE 14
WILMETTE IL
60091-2963
US

IV. Provider business mailing address

1438 W BELMONT AVE
CHICAGO IL
60657-2150
US

V. Phone/Fax

Practice location:
  • Phone: 312-508-3645
  • Fax:
Mailing address:
  • Phone: 312-508-3645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.129631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: