Healthcare Provider Details

I. General information

NPI: 1396650545
Provider Name (Legal Business Name): COLTON STRAUS LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 W DIVERSEY AVE OFC 14
CHICAGO IL
60647-1245
US

IV. Provider business mailing address

2702 N MOZART ST APT 2N
CHICAGO IL
60647-5815
US

V. Phone/Fax

Practice location:
  • Phone: 773-948-9295
  • Fax:
Mailing address:
  • Phone: 650-823-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.119441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: