Provider Demographics
NPI:1811390354
Name:RECENDEZ, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RECENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LAWTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1730 N CLARK ST
Mailing Address - Street 2:402
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5883
Mailing Address - Country:US
Mailing Address - Phone:773-234-9090
Mailing Address - Fax:
Practice Address - Street 1:1730 N CLARK ST
Practice Address - Street 2:402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5883
Practice Address - Country:US
Practice Address - Phone:773-234-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0125701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical