Provider Demographics
NPI:1215082771
Name:CHIKAHISA, MICHIKO FRANCES (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHIKO
Middle Name:FRANCES
Last Name:CHIKAHISA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W DIVERSEY PKWY
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6068
Mailing Address - Country:US
Mailing Address - Phone:312-409-3860
Mailing Address - Fax:773-296-0214
Practice Address - Street 1:4427 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5403
Practice Address - Country:US
Practice Address - Phone:773-275-7212
Practice Address - Fax:773-275-0958
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633411OtherBLUECROSS BLUESHIELD OF I
IL1633411OtherBLUECROSS BLUESHIELD OF I