Healthcare Provider Details

I. General information

NPI: 1013418375
Provider Name (Legal Business Name): LAURA CAROLINE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LAKE ST STE 201
OAK PARK IL
60301-1028
US

IV. Provider business mailing address

8043 LAKE ST
RIVER FOREST IL
60305-1685
US

V. Phone/Fax

Practice location:
  • Phone: 773-766-7010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.041633
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: