Provider Demographics
NPI:1821657289
Name:SOMAWISE CHICAGO
Entity Type:Organization
Organization Name:SOMAWISE CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-810-9553
Mailing Address - Street 1:2761 W SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4022
Mailing Address - Country:US
Mailing Address - Phone:312-810-9553
Mailing Address - Fax:
Practice Address - Street 1:2761 W SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4022
Practice Address - Country:US
Practice Address - Phone:312-810-9553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health