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General NPI Number Information
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NPI Number | 1396219499
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Entity Type | Individual
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Provider Name | TIMOTHY PAUL HIGGINS MSW
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Gender | Male
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 1900 W POLK ST STE 154
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City | CHICAGO
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State | IL
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Zip | 60612-3723
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Country | US
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Telephone | 844-433-8793
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Fax |
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Provider Business Mailing Address
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Address Line | 142 ELGIN AVE APT 3D
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City | FOREST PARK
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State | IL
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Zip | 60130-1321
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Country | US
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Telephone | 708-567-1136
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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 | 149.010273
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License Number State | IL
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