Provider Demographics
NPI:1831457076
Name:PHILLIPS, ALEXANDRA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 W 94TH PL
Mailing Address - Street 2:1B
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2172
Mailing Address - Country:US
Mailing Address - Phone:708-227-5999
Mailing Address - Fax:
Practice Address - Street 1:6530 W 94TH PL
Practice Address - Street 2:1B
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2172
Practice Address - Country:US
Practice Address - Phone:708-227-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0152291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical