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General NPI Number Information
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NPI Number | 1629753314
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Entity Type | Organization
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Legal Business Name | ILLUMINATE CLINICAL SOLUTIONS, PLLC
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 901
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City | CHICAGO
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State | IL
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Zip | 60602-3767
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Country | US
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Telephone | 312-380-9155
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N MICHIGAN AVE STE 901
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City | CHICAGO
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State | IL
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Zip | 60602-3767
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Country | US
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Telephone | 312-380-9155
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. LAURA KUPPERMAN-CARON
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Credential | PH.D.
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Telephone | 312-380-9155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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