Provider Demographics
NPI:1841951084
Name:SUTTER GRESS, MORGAN LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LYNN
Last Name:SUTTER GRESS
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 1:3328 S 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-3818
Mailing Address - Country:US
Mailing Address - Phone:708-628-7883
Mailing Address - Fax:
Practice Address - Street 1:3411 W DIVERSEY AVE STE 14
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1245
Practice Address - Country:US
Practice Address - Phone:224-534-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0237221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.023722OtherSTATE OF ILLINOIS