Provider Demographics
NPI:1679084222
Name:SZUDARSKI, LISA LADD (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LADD
Last Name:SZUDARSKI
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 1:27475 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3808
Mailing Address - Country:US
Mailing Address - Phone:630-363-1429
Mailing Address - Fax:
Practice Address - Street 1:27475 FERRY RD STE 110
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3808
Practice Address - Country:US
Practice Address - Phone:630-363-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0075931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical