Healthcare Provider Details

I. General information

NPI: 1205658531
Provider Name (Legal Business Name): MICHELLE LAUREN MAIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E WACKER DR STE 1127
CHICAGO IL
60601-5215
US

IV. Provider business mailing address

1310 VAN BUREN AVE
DES PLAINES IL
60018-1608
US

V. Phone/Fax

Practice location:
  • Phone: 312-736-1776
  • Fax:
Mailing address:
  • Phone: 773-369-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.23872
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: