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General NPI Number Information
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NPI Number | 1780412403
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Entity Type | Organization
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Legal Business Name | MARI MORTENSEN LCSW PLLC
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Dates
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Enumeration Date | 07/24/2024
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 101 N MARION ST STE 300
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City | OAK PARK
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State | IL
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Zip | 60301-1023
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Country | US
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Telephone | 708-650-4356
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Fax |
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Provider Business Mailing Address
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Address Line | 9265 WATERFALL GLEN BLVD
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City | DARIEN
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State | IL
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Zip | 60561-5282
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Country | US
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Telephone | 708-650-4356
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARI MORTENSEN
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Credential | LCSW
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Telephone | 708-650-4356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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