Provider Demographics
NPI:1821089772
Name:NORDEN, PAUL W (RCST, LMT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:NORDEN
Suffix:
Gender:M
Credentials:RCST, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 N ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7431
Mailing Address - Country:US
Mailing Address - Phone:773-294-6510
Mailing Address - Fax:
Practice Address - Street 1:4915 N ALBANY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4205
Practice Address - Country:US
Practice Address - Phone:773-583-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227-004434225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227-004434OtherLICENSED MASSAGE THERAPST