Provider Demographics
NPI:1336824028
Name:AUSMUS, ATROUS HAZEL (LSW)
Entity type:Individual
Prefix:
First Name:ATROUS
Middle Name:HAZEL
Last Name:AUSMUS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ATROUS
Other - Middle Name:HAZEL
Other - Last Name:LOLLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1185
Mailing Address - Country:US
Mailing Address - Phone:888-870-1775
Mailing Address - Fax:
Practice Address - Street 1:525 E NORTH ST STE B
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1186
Practice Address - Country:US
Practice Address - Phone:815-933-0667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.106045104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker