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General NPI Number Information
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NPI Number | 1639501125
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Entity Type | Individual
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Provider Name | DAKEDA RENEE HORTON PHD, LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 1100 S HAMILTON AVE MENTAL HEALTH DEPARTMENT
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-433-5704
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Fax |
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Provider Business Mailing Address
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Address Line | 1969 W OGDEN AVE OFC 8400
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City | CHICAGO
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State | IL
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Zip | 60612-3765
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Country | US
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Telephone | 312-864-6708
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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 | 149.013618
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071009752
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License Number State | IL
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