MEDICARE: LAUREN LUDLOW LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.015019	IL

General Provider Information

NPI Number	:	1437580370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN LUDLOW LCSW

Provider Business Mailing Address
First Line	:	4000 W MONTROSE AVE # 809
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2140
Country	:	US
Telephone Number	:	773-550-3302
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 N AVONDALE AVE
Second Line	:	STE 101
City	:	CHICAGO
State	:	IL
Zip	:	60631-1567
Country	:	US
Telephone Number	:	773-774-4444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2013
Last Update Date	:	08/15/2022

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