Provider Demographics
NPI:1902240989
Name:STORTZ, KARIN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:MARIE
Last Name:STORTZ
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 1:101 N MARION ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1167
Mailing Address - Country:US
Mailing Address - Phone:708-224-7832
Mailing Address - Fax:708-777-4447
Practice Address - Street 1:101 N MARION ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1167
Practice Address - Country:US
Practice Address - Phone:708-224-7832
Practice Address - Fax:708-777-4447
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0156871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical