Healthcare Provider Details

I. General information

NPI: 1962316331
Provider Name (Legal Business Name): CRAIG LOERTSCHER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 SPRUCE ST
QUINCY IL
62301-2062
US

IV. Provider business mailing address

1725 SPRUCE ST
QUINCY IL
62301-2062
US

V. Phone/Fax

Practice location:
  • Phone: 217-577-5292
  • Fax:
Mailing address:
  • Phone: 217-577-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149031001
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: