Provider Demographics
NPI:1306036918
Name:SMEBAKKEN, LTD.
Entity Type:Organization
Organization Name:SMEBAKKEN, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESSI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMEBAKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:847-870-0771
Mailing Address - Street 1:125 S WILKE RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1522
Mailing Address - Country:US
Mailing Address - Phone:847-870-0771
Mailing Address - Fax:
Practice Address - Street 1:125 S WILKE RD STE 200A
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1522
Practice Address - Country:US
Practice Address - Phone:847-870-0771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1609875616OtherNPI
IL1609875616OtherNPI