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General NPI Number Information
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NPI Number | 1265972962
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Entity Type | Individual
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Provider Name | JOAN D MCCOHNELL PHD, LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 723 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-3902
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Country | US
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Telephone | 312-218-8568
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Fax |
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Provider Business Mailing Address
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Address Line | 7131 S. CONSTANCE AVE
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City | CHICAGO
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State | IL
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Zip | 60649
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Country | US
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Telephone | 312-218-8568
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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 | M25448454766
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License Number State | IL
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