Provider Demographics
NPI:1003052580
Name:KNOERZER, JOHN ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANTHONY
Last Name:KNOERZER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 W SUNNYSIDE AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6331
Mailing Address - Country:US
Mailing Address - Phone:773-234-1517
Mailing Address - Fax:
Practice Address - Street 1:3850 W SUNNYSIDE AVE
Practice Address - Street 2:#304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-6331
Practice Address - Country:US
Practice Address - Phone:773-234-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490128871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical