Provider Demographics
NPI:1639501125
Name:HORTON, DAKEDA RENEE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DAKEDA
Middle Name:RENEE
Last Name:HORTON
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:DR
Other - First Name:DAKEDA
Other - Middle Name:RENEE
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCSW
Mailing Address - Street 1:1969 W OGDEN AVE OFC 8400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3765
Mailing Address - Country:US
Mailing Address - Phone:312-864-6708
Mailing Address - Fax:
Practice Address - Street 1:1100 S HAMILTON AVE
Practice Address - Street 2:MENTAL HEALTH DEPARTMENT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-433-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0136181041C0700X, 1041C0700X
IL071009752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical