Terese Youngblood, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.020079 Issued in IL

Practice address

4636 N Ravenswood Ave Ste 201
Chicago, IL 60640-4581

Phone

(312) 767-4884

NPI assigned

Oct 29, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540944000000",
    "number": "1891167870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4636 N RAVENSWOOD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4636 N RAVENSWOOD AVE STE 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404581",
            "telephone_number": "312-767-4884"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 W Diversey Pkwy",
            "address_2": "suite 275",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60614",
            "country_code": "US",
            "telephone_number": "773-281-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNGBLOOD",
        "first_name": "TERESE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-29",
        "last_updated": "2018-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.020079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Unique Young
• William Young
• Zetah Young, LCPC
• Jeffre Katherine Youngblood, COTA/L
• Mark Youngblood, MD, PHD
• Timberly Youngblood, DT
• Jewel Sophia Younge, MA, MAT, PHARMD, RPH
• Scot James Younger, ATC
• Christian Younginer, LPC
• Jonathan Michael Youngner, M.D.

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.