Provider Demographics
NPI:1033387261
Name:CLINICAL EXPRESSIONS
Entity Type:Organization
Organization Name:CLINICAL EXPRESSIONS
Other - Org Name:CLINICAL EXPRESSIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCPC, ACS
Authorized Official - Phone:815-901-3769
Mailing Address - Street 1:1729 FAIRFAX CIR E UNIT B2
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-7484
Mailing Address - Country:US
Mailing Address - Phone:815-901-3769
Mailing Address - Fax:
Practice Address - Street 1:155 N WACKER DR STE 4250
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1750
Practice Address - Country:US
Practice Address - Phone:312-262-5387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006666251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL104.3491475OtherLCPC