Healthcare Provider Details

I. General information

NPI: 1477911956
Provider Name (Legal Business Name): ILSA SURBAUGH-NAUMES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROOSEVELT RD STE 208
GLEN ELLYN IL
60137-6031
US

IV. Provider business mailing address

1200 ROOSEVELT RD STE 208
GLEN ELLYN IL
60137-6031
US

V. Phone/Fax

Practice location:
  • Phone: 312-504-1313
  • Fax:
Mailing address:
  • Phone: 312-504-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149031806
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: