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Organization
LUTHERAN SOCIAL SERVICES OF ILLINOIS
Active
Organization
LUTHERAN SOCIAL SERVICES OF ILLINOIS
Active
Other names
Portage Cragin Outpatient
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK STUTRUD (PRESIDENT)
(847) 635-4600
Entity
Organization
Contact information
Practice address
4840 W BYRON ST, CHICAGO, IL 60641-2712
(773) 282-7800
(773) 282-2163
Mailing address
1001 E TOUHY AVE STE 50, DES PLAINES, IL 60018-5817
(847) 635-4600
(847) 297-3407
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001618748
BLUE CROSS BLUE SHIELD
IL
Enumeration date
04/17/2007
Last updated
12/31/2019
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