Provider Demographics
NPI:1003868407
Name:BROGDON, JOAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:BROGDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3025
Mailing Address - Country:US
Mailing Address - Phone:773-975-7777
Mailing Address - Fax:773-975-6098
Practice Address - Street 1:4113 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3025
Practice Address - Country:US
Practice Address - Phone:773-975-7777
Practice Address - Fax:773-975-6098
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical