Provider Demographics
NPI:1043602097
Name:JUNKINS, TODD (LCSW)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:JUNKINS
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 1:53 W JACKSON BLVD STE 1632
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3606
Mailing Address - Country:US
Mailing Address - Phone:847-563-4010
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 1632
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3606
Practice Address - Country:US
Practice Address - Phone:847-563-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-28
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150015340104100000X
IL149.0193611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker