Healthcare Provider Details

I. General information

NPI: 1376450387
Provider Name (Legal Business Name): LAURA LEE LAURSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S VAN BUREN ST
BATAVIA IL
60510-2751
US

IV. Provider business mailing address

409 S VAN BUREN ST
BATAVIA IL
60510-2751
US

V. Phone/Fax

Practice location:
  • Phone: 630-319-2094
  • Fax:
Mailing address:
  • Phone: 630-319-2094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: