Individual
BLANCA LUCILLE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2355 S WESTERN AVE, CHICAGO, IL 60608-3837
(773) 254-1400
(773) 650-1239
Mailing address
966 W 21ST ST, CHICAGO, IL 60608-4511
(773) 254-1400
(773) 650-1239
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
149018185
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IL
Enumeration date
08/04/2011
Last updated
01/19/2017
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