Provider Demographics
NPI:1871623330
Name:HEINTZEN, ERICH HUGO IV (LCSW)
Entity type:Individual
Prefix:MR
First Name:ERICH
Middle Name:HUGO
Last Name:HEINTZEN
Suffix:IV
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:5842 N WAYNE AVE
Mailing Address - Street 2:UNIT G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3467
Mailing Address - Country:US
Mailing Address - Phone:773-612-6206
Mailing Address - Fax:773-880-1321
Practice Address - Street 1:1300 W BELMONT AVE
Practice Address - Street 2:SUITE 400E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:773-880-1310
Practice Address - Fax:773-880-1321
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical