Provider Demographics
NPI:1457418162
Name:YABLONSKI, CONSTANCE (LCSW)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:YABLONSKI
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 1:6038 N NEWBURG AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2602
Mailing Address - Country:US
Mailing Address - Phone:773-775-5313
Mailing Address - Fax:
Practice Address - Street 1:6321 N AVONDALE AVE STE A101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1900
Practice Address - Country:US
Practice Address - Phone:773-774-7555
Practice Address - Fax:773-774-8910
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203239Medicare ID - Type Unspecified