Provider Demographics
NPI:1194901769
Name:JOHN A ATKIN, L.C.S.W
Entity type:Organization
Organization Name:JOHN A ATKIN, L.C.S.W
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:SOCIAL WORKER
Authorized Official - Phone:630-545-2835
Mailing Address - Street 1:751 ROOSEVELT RD
Mailing Address - Street 2:STE 213
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5904
Mailing Address - Country:US
Mailing Address - Phone:630-545-2835
Mailing Address - Fax:630-545-2895
Practice Address - Street 1:6912 MAIN ST STE 28
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3447
Practice Address - Country:US
Practice Address - Phone:630-235-4229
Practice Address - Fax:630-545-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1490020451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL530060Medicaid
IL0002221807OtherBCBS PROVIDER #