Healthcare Provider Details

I. General information

NPI: 1780412403
Provider Name (Legal Business Name): MARI MORTENSEN LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MARION ST STE 300
OAK PARK IL
60301-1023
US

IV. Provider business mailing address

9265 WATERFALL GLEN BLVD
DARIEN IL
60561-5282
US

V. Phone/Fax

Practice location:
  • Phone: 708-650-4356
  • Fax:
Mailing address:
  • Phone: 708-650-4356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARI MORTENSEN
Title or Position: OWNER
Credential: LCSW
Phone: 708-650-4356