Provider Demographics
NPI:1679337190
Name:SEVERSON, LOIS ANITA (LCSW, MAC, SAP, CEAP)
Entity type:Individual
Prefix:MS
First Name:LOIS
Middle Name:ANITA
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:LCSW, MAC, SAP, CEAP
Other - Prefix:MS
Other - First Name:LOIS
Other - Middle Name:ANITA
Other - Last Name:KENYON-SEVERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, MAC, CEAP, SAP
Mailing Address - Street 1:20331 HELLENIC DR
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1419
Mailing Address - Country:US
Mailing Address - Phone:708-275-6131
Mailing Address - Fax:
Practice Address - Street 1:20331 HELLENIC DR
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1419
Practice Address - Country:US
Practice Address - Phone:708-275-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010938551041C0700X
IN33002748A1041C0700X
IL149-0064261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical