Provider Demographics
NPI:1164837779
Name:SLADE, JORI (LCSW)
Entity Type:Individual
Prefix:
First Name:JORI
Middle Name:
Last Name:SLADE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JORI
Other - Middle Name:
Other - Last Name:ELISCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:800 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4906
Mailing Address - Country:US
Mailing Address - Phone:773-702-0556
Mailing Address - Fax:773-834-2314
Practice Address - Street 1:800 E 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4906
Practice Address - Country:US
Practice Address - Phone:773-702-0556
Practice Address - Fax:773-834-2314
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0149211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical