Provider Demographics
NPI:1588104483
Name:KLOWDEN, LARRY (LCSW)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:KLOWDEN
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 1:446 E ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4418
Mailing Address - Country:US
Mailing Address - Phone:312-926-1473
Mailing Address - Fax:312-926-7960
Practice Address - Street 1:446 E ONTARIO ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4418
Practice Address - Country:US
Practice Address - Phone:312-926-1473
Practice Address - Fax:312-926-7960
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0086201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical