Provider Demographics
NPI:1902582026
Name:MEDOW, LANA (LCSW)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:MEDOW
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 1:400 CENTRAL AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3039
Mailing Address - Country:US
Mailing Address - Phone:847-309-5855
Mailing Address - Fax:
Practice Address - Street 1:400 CENTRAL AVE STE 250
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3039
Practice Address - Country:US
Practice Address - Phone:847-309-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490105161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical