Healthcare Provider Details

I. General information

NPI: 1295277234
Provider Name (Legal Business Name): LENORE DEUTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 SHERWOOD DR SUITE 201
LAKE BLUFF IL
60044-2203
US

IV. Provider business mailing address

NSPT 950 LEE STREET SUITE 210
DES PLAINES IL
60016-6532
US

V. Phone/Fax

Practice location:
  • Phone: 877-486-4140
  • Fax:
Mailing address:
  • Phone: 877-486-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149001594
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: