Provider Demographics
NPI:1790279909
Name:SOLVEIG ROVERUD LCSW
Entity Type:Organization
Organization Name:SOLVEIG ROVERUD LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SOLVEIG
Authorized Official - Middle Name:
Authorized Official - Last Name:ROVERUD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-671-5727
Mailing Address - Street 1:5447 N WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1304
Mailing Address - Country:US
Mailing Address - Phone:773-671-5727
Mailing Address - Fax:
Practice Address - Street 1:5138 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2828
Practice Address - Country:US
Practice Address - Phone:773-671-5727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)