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General NPI Number Information
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NPI Number | 1841715620
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Entity Type | Individual
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Provider Name | LAUREN MAE NIEDERKORN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 2334 W LAWRENCE AVE STE 204
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City | CHICAGO
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State | IL
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Zip | 60625-1045
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Country | US
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Telephone | 847-920-6094
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Fax |
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Provider Business Mailing Address
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Address Line | 8817 MANGO AVE
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City | MORTON GROVE
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State | IL
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Zip | 60053-2539
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Country | US
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Telephone | 773-559-4924
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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 | 149.020085
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.102093
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License Number State | IL
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