Provider Demographics
NPI:1083508592
Name:SEVERSEN, MEREDITH (LCPC)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:SEVERSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:SEVERSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:4714 W IRVING PARK RD APT 313
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1215
Mailing Address - Country:US
Mailing Address - Phone:206-591-8431
Mailing Address - Fax:
Practice Address - Street 1:4714 W IRVING PARK RD APT 313
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1215
Practice Address - Country:US
Practice Address - Phone:206-591-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178018875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty