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NPI Code Detail

MEDICARE: MS. LARA LIESMA WOLFF LCPC

MEDICARE: MS. LARA LIESMA WOLFF LCPC
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 Counselor180.012328IL
2101YP2500XProfessional CounselorCC04861MN

General Provider Information

NPI Number : 1568839314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LARA LIESMA WOLFF LCPC
Provider Business Mailing Address
First Line : 213 W INSTITUTE PL STE 500
Second Line :
City : CHICAGO
State : IL
Zip : 60610-8792
Country : US
Telephone Number : 773-954-9315
Fax Number :
Provider Business Practice Location Address
First Line : 213 W INSTITUTE PL STE 500
Second Line :
City : CHICAGO
State : IL
Zip : 60610-8792
Country : US
Telephone Number : 773-482-1988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2015
Last Update Date : 06/19/2026

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