Provider Demographics
NPI:1245945286
Name:LINDAHL, TERESA BERNADETTE (LSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:BERNADETTE
Last Name:LINDAHL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W JUDD ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3199
Mailing Address - Country:US
Mailing Address - Phone:815-345-3400
Mailing Address - Fax:
Practice Address - Street 1:224 W JUDD ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3199
Practice Address - Country:US
Practice Address - Phone:815-345-3400
Practice Address - Fax:844-734-1259
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1099601041C0700X
IL150109960104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical