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General NPI Number Information
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NPI Number | 1750160248
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Entity Type | Organization
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Legal Business Name | RIPTIDE CURRENTS
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 5306 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-1104
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Country | US
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Telephone | 773-259-2543
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Fax |
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Provider Business Mailing Address
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Address Line | 433 W BRIAR PL APT 5C
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City | CHICAGO
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State | IL
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Zip | 60657-4762
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Country | US
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Telephone | 401-871-6996
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | JEAN HAUSMANN
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Credential | LCSW
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Telephone | 401-871-6996
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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 |
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License Number State |
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