=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730098856
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERICA CLEVELAND LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2026
-----------------------------------------------------
Last Update Date | 09/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 VICTORIA ST
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60002-1519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-267-5313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 696 INDIAN RIDGE DR
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60002-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 150.131570
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------