| Lutheran Social Services Of Il | |
|
308 W State St Ste 205 Rockford IL 61101-1117 | |
| (815) 969-8836 | |
| (815) 969-8871 |
| Full Name | Lutheran Social Services Of Il |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 308 W State St Ste 205, Rockford, Illinois |
| Authorized Official Name and Position | Mark Stutrud (PRESIDENT) |
| Authorized Official Contact | 8476354600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lutheran Social Services Of Il 1001 E Touhy Ave Suite 50 Des Plaines IL 60018-5801 Ph: (847) 635-4600 | Lutheran Social Services Of Il 308 W State St Ste 205 Rockford IL 61101-1117 Ph: (815) 969-8836 |
| NPI Number | 1366762064 |
|---|---|
| Provider Enumeration Date | 06/03/2010 |
| Last Update Date | 01/08/2020 |
| Certification Date | 01/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366762064 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 04092 (Illinois) | Primary |
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