Healthcare Provider Details

I. General information

NPI: 1982527065
Provider Name (Legal Business Name): SOMA & SER THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 N RAVENSWOOD AVE STE 201.5
CHICAGO IL
60640-8038
US

IV. Provider business mailing address

4525 N RAVENSWOOD AVE STE 201.5
CHICAGO IL
60640-8038
US

V. Phone/Fax

Practice location:
  • Phone: 815-735-8045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA ISABELLA LUNDGREN-CLARK
Title or Position: PSYCHOTHERAPIST
Credential: LCPC
Phone: 815-735-8045