Provider Demographics
NPI:1700905122
Name:HURDER, MARGARET LYNNE
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:LYNNE
Last Name:HURDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LYNNE
Other - Middle Name:ANCHORS
Other - Last Name:HURDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW CSADC
Mailing Address - Street 1:6301 NO SHERIDAN RD
Mailing Address - Street 2:#611
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660
Mailing Address - Country:US
Mailing Address - Phone:773-761-1687
Mailing Address - Fax:
Practice Address - Street 1:6301 NO SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660
Practice Address - Country:US
Practice Address - Phone:773-761-1687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2176988110101YA0400X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2860073Medicare ID - Type Unspecified