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General NPI Number Information
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NPI Number | 1609998756
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Entity Type | Individual
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Provider Name | LORRAINE RUCKER LCSW CEAP SAP
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Gender | Female
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 333 N MICHIGAN SUITE 1801
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City | CHICAGO
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State | IL
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Zip | 60601
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Country | US
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Telephone | 708-445-6110
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Fax | 773-379-6472
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Provider Business Mailing Address
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Address Line | PO BOX 979
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City | OAK PARK
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State | IL
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Zip | 60306
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Country | US
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Telephone | 708-445-6110
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Fax | 773-379-6472
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | IL
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