Healthcare Provider Details

I. General information

NPI: 1275019952
Provider Name (Legal Business Name): SOLVEIG ROVERUD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: K SOLVEIG ROVERUD ROSCHEN LCSW

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5138 N CLARK ST
CHICAGO IL
60640-2828
US

IV. Provider business mailing address

5447 N WAYNE AVE
CHICAGO IL
60640-1304
US

V. Phone/Fax

Practice location:
  • Phone: 773-671-5727
  • Fax:
Mailing address:
  • Phone: 773-671-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.006255
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: