Provider Demographics
NPI:1750644431
Name:SOHN, AUGUSTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:
Last Name:SOHN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1358
Mailing Address - Country:US
Mailing Address - Phone:708-215-1676
Mailing Address - Fax:
Practice Address - Street 1:4710 LINCOLN HWY
Practice Address - Street 2:321
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2316
Practice Address - Country:US
Practice Address - Phone:773-420-3481
Practice Address - Fax:773-420-3597
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490142531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical