Provider Demographics
NPI:1629753314
Name:ILLUMINATE CLINICAL SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:ILLUMINATE CLINICAL SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPPERMAN-CARON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-380-9155
Mailing Address - Street 1:1517 W BARRY AVE # 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8911
Mailing Address - Country:US
Mailing Address - Phone:312-380-9155
Mailing Address - Fax:
Practice Address - Street 1:1517 W BARRY AVE # 2W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-8911
Practice Address - Country:US
Practice Address - Phone:312-380-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty