MEDICARE: SOUTHWORTH THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245183789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWORTH THERAPY LLC

Provider Business Mailing Address
First Line	:	1655 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2133
Country	:	US
Telephone Number	:	502-548-9482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2133
Country	:	US
Telephone Number	:	502-548-9482
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JILLIAN MORRISON SOUTHWORTH
Credential	:	LCSW
Telephone Number	:	502-548-9482

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “SOUTHWORTH THERAPY LLC ” Practice Location

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