Provider Demographics
NPI:1619742491
Name:FERGUSON, CHELSEA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:FERGUSON
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 1:109 FAIRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2247
Mailing Address - Country:US
Mailing Address - Phone:309-264-5381
Mailing Address - Fax:
Practice Address - Street 1:1946 EDWARDSVILLE CLUB PLAZA CT
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3717
Practice Address - Country:US
Practice Address - Phone:618-248-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0261251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical