Provider Demographics
NPI:1750875159
Name:DOBROWSKI, JORDAN A (LCSW)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:A
Last Name:DOBROWSKI
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 1:1658 N MILWAUKEE AVE # 3671
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6905
Mailing Address - Country:US
Mailing Address - Phone:872-365-5086
Mailing Address - Fax:800-991-2996
Practice Address - Street 1:1658 N MILWAUKEE AVE # 3671
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6905
Practice Address - Country:US
Practice Address - Phone:872-365-6087
Practice Address - Fax:800-991-2996
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0221461041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL447252437001Medicaid