Provider Demographics
NPI:1326662313
Name:KOHN SHAKERI, HANNAH SOPHIA (LCSW)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:SOPHIA
Last Name:KOHN SHAKERI
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 1:2020 S ALLPORT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3210
Mailing Address - Country:US
Mailing Address - Phone:703-963-0517
Mailing Address - Fax:
Practice Address - Street 1:1803 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5105
Practice Address - Country:US
Practice Address - Phone:773-819-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490241731041C0700X
MI6801105385104100000X
IL24440691041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool