Provider Demographics
NPI:1417418914
Name:CONNELLY, MONICA (MSW, CADC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MSW, CADC
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:SIMONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 N LAKE SHORE DR STE 800
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2402
Mailing Address - Country:US
Mailing Address - Phone:312-481-6811
Mailing Address - Fax:
Practice Address - Street 1:800 N LAKE SHORE DR STE 800
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2402
Practice Address - Country:US
Practice Address - Phone:312-481-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33773101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL33773OtherCERTIFIED ALCOHOL AND DRUG ABUSE COUNSELOR