Provider Demographics
NPI:1588296412
Name:MORGAN-LOPEZ, ILANA BLAIR (LCSW)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:BLAIR
Last Name:MORGAN-LOPEZ
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 1:715 LAKE ST STE 517A
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1414
Mailing Address - Country:US
Mailing Address - Phone:708-628-6546
Mailing Address - Fax:
Practice Address - Street 1:715 LAKE ST STE 517A
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1414
Practice Address - Country:US
Practice Address - Phone:708-628-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0187441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical