Healthcare Provider Details

I. General information

NPI: 1689609455
Provider Name (Legal Business Name): MARLENE ERDMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 SEQUOIA DR
AURORA IL
60506-6209
US

IV. Provider business mailing address

2357 SEQUOIA DR
AURORA IL
60506-6222
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-6700
  • Fax:
Mailing address:
  • Phone: 630-859-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150-001578
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: