Provider Demographics
NPI:1477914406
Name:HORN, TONJA (LCSW)
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:
Last Name:HORN
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 1:1447 S. CUYLER AVE.
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402
Mailing Address - Country:US
Mailing Address - Phone:708-557-1171
Mailing Address - Fax:
Practice Address - Street 1:1111 CHICAGO AVE.
Practice Address - Street 2:STE. 222
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-6030
Practice Address - Country:US
Practice Address - Phone:708-303-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0180431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical