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General NPI Number Information
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NPI Number | 1003957762
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Entity Type | Individual
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Provider Name | DAVID AMBROSE HODGSON L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 1226 E MADISON PARK #2
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City | CHICAGO
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State | IL
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Zip | 60615-2959
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Country | US
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Telephone | 708-351-3137
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Fax |
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Provider Business Mailing Address
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Address Line | 1226 E MADISON PARK APT 2
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City | CHICAGO
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State | IL
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Zip | 60615-2959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.003641
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License Number State | IL
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