Provider Demographics
NPI:1609998756
Name:RUCKER, LORRAINE (LCSW CEAP SAP)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:LCSW CEAP SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60306
Mailing Address - Country:US
Mailing Address - Phone:708-445-6110
Mailing Address - Fax:773-379-6472
Practice Address - Street 1:333 N MICHIGAN
Practice Address - Street 2:SUITE 1801
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:708-445-6110
Practice Address - Fax:773-379-6472
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical