Provider Demographics
NPI:1861790651
Name:RIOS, LETICIA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:RIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 N SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2210
Mailing Address - Country:US
Mailing Address - Phone:773-549-5886
Mailing Address - Fax:773-549-5892
Practice Address - Street 1:3225 N SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2210
Practice Address - Country:US
Practice Address - Phone:773-549-5886
Practice Address - Fax:773-549-5892
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL149-0154131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker