Provider Demographics
NPI:1578665501
Name:MOGAB, JONNA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JONNA
Middle Name:
Last Name:MOGAB
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 1:1614 W BETEAU AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1809
Mailing Address - Country:US
Mailing Address - Phone:773-880-1327
Mailing Address - Fax:773-880-0961
Practice Address - Street 1:1614 W BERTEAU AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1809
Practice Address - Country:US
Practice Address - Phone:773-880-1327
Practice Address - Fax:773-880-0961
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical