Provider Demographics
NPI:1689385031
Name:WHITE, VICTORIA L (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4368 E 2940TH RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IL
Mailing Address - Zip Code:60551-9670
Mailing Address - Country:US
Mailing Address - Phone:630-217-1826
Mailing Address - Fax:
Practice Address - Street 1:4368 E 2940TH RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IL
Practice Address - Zip Code:60551-9670
Practice Address - Country:US
Practice Address - Phone:630-217-1826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150010736104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker