Provider Demographics
NPI:1477205086
Name:HORK, CORI
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:
Last Name:HORK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 CLAVINIA AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3913
Mailing Address - Country:US
Mailing Address - Phone:847-494-3337
Mailing Address - Fax:
Practice Address - Street 1:600 WAUKEGAN RD STE 132
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1249
Practice Address - Country:US
Practice Address - Phone:847-748-8733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490146371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH62011076872OtherDRIVERS LICENSE