Provider Demographics
NPI:1720259591
Name:KHAN, AISHA ALI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AISHA
Middle Name:ALI
Last Name:KHAN
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 1:4155 CRIMSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192
Mailing Address - Country:US
Mailing Address - Phone:312-498-7311
Mailing Address - Fax:
Practice Address - Street 1:4155 CRIMSON DR
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-1237
Practice Address - Country:US
Practice Address - Phone:312-498-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490125531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical