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NPI Code Detail

MEDICARE: MRS. KELLY LAPORTE M.A, L.P.C., C.A.D.C

MEDICARE: MRS. KELLY LAPORTE M.A, L.P.C., C.A.D.C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor178.007762IL

General Provider Information

NPI Number : 1235408618
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY LAPORTE M.A, L.P.C., C.A.D.C
Provider Business Mailing Address
First Line : 36 MAIN ST
Second Line : SUITE 106
City : PARK RIDGE
State : IL
Zip : 60068-4059
Country : US
Telephone Number : 708-601-1185
Fax Number : 888-440-2577
Provider Business Practice Location Address
First Line : 36 MAIN ST
Second Line : SUITE 106
City : PARK RIDGE
State : IL
Zip : 60068-4059
Country : US
Telephone Number : 708-601-1185
Fax Number : 888-440-2577
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2011
Last Update Date : 12/14/2011

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