NPIMap

Organization Active NPI

Lutheran Social Services of Illinois

Doing business as LSSI Blue Island

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Blue Island, IL
National Provider Identifier
1710599956
Registry record updated Aug 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LUTHERAN SOCIAL SERVICES OF ILLINOIS
Doing business as
LSSI Blue Island
Practice address
12940 Western Ave Ste 300
Blue Island, IL 60406-4154
Phone
(708) 489-2894
Fax
(708) 489-5413
NPI assigned
Aug 19, 2020
Last updated
Aug 19, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Stutrud
Title
President
Phone
(847) 635-4600

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X
Clinical Social Worker 1041C0700X
Family Medicine Physician 207Q00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Nurse Practitioner 363L00000X

Addresses

Primary practice location

12940 Western Ave Ste 300
Blue Island, IL 60406-4154

Mailing address

1001 E Touhy Ave Ste 50
Des Plaines, IL 60018-5817
Phone (847) 635-4600

Other names 1

  • LSSI Blue Island Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lutheran Social Services of Illinois65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

12940 Western Ave
Ste 300
Blue Island, IL 60406
Phone (708) 489-2894

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1710599956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E TOUHY AVE STE 50",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600185817",
            "telephone_number": "847-635-4600",
            "fax_number": "847-297-3407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12940 WESTERN AVE STE 300",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604064154",
            "telephone_number": "708-489-2894",
            "fax_number": "708-489-5413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN SOCIAL SERVICES OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "STUTRUD",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-635-4600"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LSSI Blue Island",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blue Island, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.