Provider Demographics
NPI:1760629117
Name:ROSS, ALEC (MSW,LCSW,RDDP)
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:MSW,LCSW,RDDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1609
Mailing Address - Country:US
Mailing Address - Phone:847-835-5111
Mailing Address - Fax:
Practice Address - Street 1:675 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1609
Practice Address - Country:US
Practice Address - Phone:847-835-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0046971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical