Provider Demographics
NPI:1043865132
Name:GOLDEN, ALEXIS ANYA (LSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANYA
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9444 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1455
Mailing Address - Country:US
Mailing Address - Phone:847-293-3296
Mailing Address - Fax:
Practice Address - Street 1:150 S WACKER DR STE 2400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-4211
Practice Address - Country:US
Practice Address - Phone:847-293-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103835104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker