Provider Demographics
NPI:1336676568
Name:HUSSAR, LAUREN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:HUSSAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N. MICHIGAN AVE
Mailing Address - Street 2:STE 566
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7799
Mailing Address - Country:US
Mailing Address - Phone:708-628-7076
Mailing Address - Fax:
Practice Address - Street 1:155 N. MICHIGAN AVE
Practice Address - Street 2:STE 566
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7799
Practice Address - Country:US
Practice Address - Phone:708-628-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical