Provider Demographics
NPI:1528412632
Name:THOMPSON, COURTNEY (LSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 W DIVERSEY PKWY APT 210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-8386
Mailing Address - Country:US
Mailing Address - Phone:773-896-4072
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 424
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3844
Practice Address - Country:US
Practice Address - Phone:312-279-9981
Practice Address - Fax:312-279-9981
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150101571104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL150101571OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION