Provider Demographics
NPI:1841337730
Name:YUTZY, DANIEL D (MSW, ACSW LCSW LSCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:YUTZY
Suffix:
Gender:M
Credentials:MSW, ACSW LCSW LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 W FOSTER AVE
Mailing Address - Street 2:STORE A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4806
Mailing Address - Country:US
Mailing Address - Phone:773-583-3641
Mailing Address - Fax:
Practice Address - Street 1:3420 W FOSTER AVE
Practice Address - Street 2:STORE A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4806
Practice Address - Country:US
Practice Address - Phone:773-583-3641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS47181041C0700X
IL149-0055621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical