Provider Demographics
NPI:1922368760
Name:POLLOCK, JO A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:A
Last Name:POLLOCK
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 1:2305 W GRAND AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1661
Mailing Address - Country:US
Mailing Address - Phone:217-473-5399
Mailing Address - Fax:
Practice Address - Street 1:2305 W GRAND AVE APT 1F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1661
Practice Address - Country:US
Practice Address - Phone:217-473-5399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490147361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical