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General NPI Number Information
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NPI Number | 1639647209
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Entity Type | Individual
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Provider Name | LORI HUNSAKER SMITH
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Gender | Female
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 2650 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60608-5146
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Country | US
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Telephone | 773-674-7202
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Fax |
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Provider Business Mailing Address
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Address Line | 8948 S MOZART AVE
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-1256
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Country | US
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Telephone | 312-504-7289
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Fax |
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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 | 149003588
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License Number State | IL
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