Provider Demographics
NPI:1831499797
Name:WADERLOW, CYNTHIA JEAN (MSE,LCSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JEAN
Last Name:WADERLOW
Suffix:
Gender:F
Credentials:MSE,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 E 55TH ST
Mailing Address - Street 2:#604
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5992
Mailing Address - Country:US
Mailing Address - Phone:773-546-8704
Mailing Address - Fax:
Practice Address - Street 1:1755 E 55TH ST
Practice Address - Street 2:#604
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5992
Practice Address - Country:US
Practice Address - Phone:773-546-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0111681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical