Provider Demographics
NPI:1285200907
Name:TAN, JINGRU (LCSW)
Entity Type:Individual
Prefix:
First Name:JINGRU
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1445 N CLEVELAND AVE APT D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1132
Mailing Address - Country:US
Mailing Address - Phone:312-478-0452
Mailing Address - Fax:
Practice Address - Street 1:1445 N CLEVELAND AVE APT D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1132
Practice Address - Country:US
Practice Address - Phone:312-478-0452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0213981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical