Provider Demographics
NPI:1841715620
Name:NIEDERKORN, LAUREN MAE (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MAE
Last Name:NIEDERKORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 MANGO AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2539
Mailing Address - Country:US
Mailing Address - Phone:773-559-4924
Mailing Address - Fax:
Practice Address - Street 1:2334 W LAWRENCE AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1045
Practice Address - Country:US
Practice Address - Phone:847-920-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0200851041C0700X
IL150.102093104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker