Individual
ETHEL ROSE GUGENHEIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
3924 W DEVON AVE, LINCOLNWOOD, IL 60712-1040
(872) 262-6112
Mailing address
6450 N MOZART ST APT 3, CHICAGO, IL 60645-5873
(773) 971-1641
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150109052
IL
Other
Enumeration date
10/19/2022
Last updated
10/19/2022
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