Provider Demographics
NPI:1427693951
Name:SWIERINGA, WILLIAM B (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:SWIERINGA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 S EAST END AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-6022
Mailing Address - Country:US
Mailing Address - Phone:312-288-5059
Mailing Address - Fax:
Practice Address - Street 1:4940 S EAST END AVE APT 2A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-6022
Practice Address - Country:US
Practice Address - Phone:312-288-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0101421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06575749OtherSECRETARY OF STATE FILE NUMBER