Provider Demographics
NPI:1174212419
Name:FITTERER, PAIGE JUSTINE (LCSW)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:JUSTINE
Last Name:FITTERER
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 1:542 W CROCKETT AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1811
Mailing Address - Country:US
Mailing Address - Phone:701-290-7268
Mailing Address - Fax:
Practice Address - Street 1:381 N YORK ST STE 20
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2300
Practice Address - Country:US
Practice Address - Phone:701-290-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12729731041S0200X
IL1490255601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool