Provider Demographics
NPI:1811460108
Name:HOUSE, CORINNA (LCSW CADC)
Entity type:Individual
Prefix:DR
First Name:CORINNA
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LCSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 LINCOLN STATION DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8138
Mailing Address - Country:US
Mailing Address - Phone:630-696-6459
Mailing Address - Fax:
Practice Address - Street 1:644 LINCOLN STATION DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8138
Practice Address - Country:US
Practice Address - Phone:630-696-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.102261104100000X
IL149.0209381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker