Shaniqua Ford – Clinical Social Worker

Key facts

NPI: 1033620760
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: 149.022079 (IL)
Practice address: 4137 Sauk TRL Ste 217
Richton Park, IL 60471-1253
Phone: (708) 580-6042
Fax: (855) 595-1082
NPI assigned: Oct 20, 2017
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Soul Werk Cafe PLLC Clinical Social Worker · Richton Park, IL · NPI 1750986279

NPD CLINICAL

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
149.022079	IL	MD	Clinical Social Worker

Practice roles

Organization	Specialty	Status	New patients
Soul Werk Cafe PLLC	Clinical	Current since Apr 9, 2024	Accepting new patients

Locations

4137 Sauk Trl
Ste 217
Richton Park, IL 60471
Phone (708) 580-6042

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X
Clinical Social Worker	1041C0700X	149.022079	IL	Yes

Addresses

Primary practice location

4137 Sauk TRL Ste 217
Richton Park, IL 60471-1253

Mailing address

4137 Sauk TRL Ste 217
Richton Park, IL 60471-1253
Phone (708) 580-6042

Other providers in Richton Park, IL

All providers in Richton Park, IL · Clinical Social Worker in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.