Provider Demographics
NPI:1871743021
Name:JORDAN, ILLANA CATHLEEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:ILLANA
Middle Name:CATHLEEN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6149 N CLAREMONT AVE
Mailing Address - Street 2:2N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-5260
Mailing Address - Country:US
Mailing Address - Phone:773-930-8681
Mailing Address - Fax:
Practice Address - Street 1:6149 N CLAREMONT AVE
Practice Address - Street 2:2N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-5260
Practice Address - Country:US
Practice Address - Phone:773-930-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490154481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical