Provider Demographics
NPI:1952759714
Name:TOBIN, ASHLEY (SW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:TOBIN
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 N CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630
Mailing Address - Country:US
Mailing Address - Phone:651-792-5700
Mailing Address - Fax:630-787-0484
Practice Address - Street 1:4422 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4530
Practice Address - Country:US
Practice Address - Phone:651-792-5700
Practice Address - Fax:630-787-0484
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IL150.110326104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist