Healthcare Provider Details

I. General information

NPI: 1528986627
Provider Name (Legal Business Name): CLAIRE MARIE SOUPENE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 513-470-2939
  • Fax:
Mailing address:
  • Phone: 312-227-4921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.117373
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: