Healthcare Provider Details

I. General information

NPI: 1396392502
Provider Name (Legal Business Name): LAURA KATHRYN STRADER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LK STRADER

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 W BELMONT AVE # 1091
CHICAGO IL
60618-6471
US

IV. Provider business mailing address

2155 W BELMONT AVE # 1091
CHICAGO IL
60618-6471
US

V. Phone/Fax

Practice location:
  • Phone: 312-772-6648
  • Fax:
Mailing address:
  • Phone: 312-772-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number106.001876
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: