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General NPI Number Information
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NPI Number | 1053029041
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Entity Type | Individual
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Provider Name | ERICKA WHITLEY
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Gender | Female
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 7930 OGLESBY AVE
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City | CHICAGO
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State | IL
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Zip | 60617
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Country | US
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Telephone | 773-953-2126
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Fax |
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Provider Business Mailing Address
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Address Line | 10208 S INDIANAPOLIS AVE STE 358
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City | CHICAGO
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State | IL
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Zip | 60617-6033
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Country | US
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Telephone | 773-953-2126
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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 | 149024636
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License Number State | IL
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