Healthcare Provider Details

I. General information

NPI: 1881402030
Provider Name (Legal Business Name): LAUREN LADERE LPC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 W WINCHESTER RD STE 108
LIBERTYVILLE IL
60048-5355
US

IV. Provider business mailing address

911 W NEWPORT AVE APT 1
CHICAGO IL
60657-9565
US

V. Phone/Fax

Practice location:
  • Phone: 224-424-4194
  • Fax:
Mailing address:
  • Phone: 219-741-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.021054
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: