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General NPI Number Information
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NPI Number | 1720203326
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Entity Type | Organization
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Legal Business Name | LUTHERAN SOCIAL SERVICES OF ILLINOIS
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 6321 N AVONDALE AVE SUITE A 101
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City | CHICAGO
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State | IL
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Zip | 60631-1900
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Country | US
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Telephone | 773-774-7555
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Fax | 773-774-8910
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Provider Business Mailing Address
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Address Line | 1001 E TOUHY AVE SUITE 170
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City | DES PLAINES
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State | IL
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Zip | 60018-5801
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Country | US
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Telephone | 847-635-4600
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Fax | 847-297-3407
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. GERALD NOONAN
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Credential |
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Telephone | 847-635-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent 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 | 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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