Provider Demographics
NPI:1861718058
Name:OSCARSSON, INGRID E (LCPC)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:E
Last Name:OSCARSSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:E
Other - Last Name:OSCARSSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:1740 W FOSTER AVE
Mailing Address - Street 2:1R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2044
Mailing Address - Country:US
Mailing Address - Phone:312-925-0423
Mailing Address - Fax:
Practice Address - Street 1:4636 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4581
Practice Address - Country:US
Practice Address - Phone:312-925-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional