Provider Demographics
NPI:1497194070
Name:NORTH SHORE FAMILY SERVICES
Entity Type:Organization
Organization Name:NORTH SHORE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:847-668-4295
Mailing Address - Street 1:900 SKOKIE BOULEVARD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:847-668-4295
Mailing Address - Fax:847-668-4295
Practice Address - Street 1:900 SKOKIE BOULEVARD
Practice Address - Street 2:SUITE 218
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-668-4295
Practice Address - Fax:847-668-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490090421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1861799355OtherINDIVIDUAL NPI