Healthcare Provider Details

I. General information

NPI: 1154108066
Provider Name (Legal Business Name): LAUREL MEIBORG LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DAVIS ST
EVANSTON IL
60201-4619
US

IV. Provider business mailing address

1426 W GRANVILLE AVE APT 2
CHICAGO IL
60660-1810
US

V. Phone/Fax

Practice location:
  • Phone: 312-546-4193
  • Fax: 312-530-0390
Mailing address:
  • Phone: 630-802-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.041660
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: