Provider Demographics
NPI:1528193737
Name:LUTHERAN SOCIAL SERVICES OF ILLINOIS
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOVDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-993-0100
Mailing Address - Street 1:1927 E ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5937
Mailing Address - Country:US
Mailing Address - Phone:630-665-9208
Mailing Address - Fax:630-665-9208
Practice Address - Street 1:544 S. CORNELL ST.
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-993-0100
Practice Address - Fax:630-472-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health