Provider Demographics
NPI:1639527120
Name:CHESEBRO, NORENE
Entity Type:Individual
Prefix:MS
First Name:NORENE
Middle Name:
Last Name:CHESEBRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N LA SALLE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3503
Mailing Address - Country:US
Mailing Address - Phone:312-655-7071
Mailing Address - Fax:312-382-1612
Practice Address - Street 1:1717 RAND RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3509
Practice Address - Country:US
Practice Address - Phone:847-376-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0052581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical