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General NPI Number Information
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NPI Number | 1659951481
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Entity Type | Organization
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Legal Business Name | LOYOLA UNIVERSITY CHICAGO WELLNESS CENTER
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 6439 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60626-5364
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Country | US
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Telephone | 773-508-2530
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Fax |
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Provider Business Mailing Address
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Address Line | 6439 N SHERIDAN RD
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City | CHICAGO
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State | IL
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Zip | 60626-5364
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR
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Name | LANAY SAMUELSON
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Credential | APRN
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Telephone | 312-915-6374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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