Provider Demographics
NPI:1861117442
Name:IRBY, CORTNIE MARIE (MSW, LSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:CORTNIE
Middle Name:MARIE
Last Name:IRBY
Suffix:
Gender:F
Credentials:MSW, LSW, LCSW
Other - Prefix:
Other - First Name:CORTNIE
Other - Middle Name:MARIE
Other - Last Name:RIORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LSW, LCSW
Mailing Address - Street 1:2205 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3936
Mailing Address - Country:US
Mailing Address - Phone:888-428-7890
Mailing Address - Fax:
Practice Address - Street 1:2205 STATE ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3936
Practice Address - Country:US
Practice Address - Phone:888-428-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150107283104100000X
IL1490264881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker