Healthcare Provider Details

I. General information

NPI: 1447713144
Provider Name (Legal Business Name): LAURA NESSLER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 N RAVENSWOOD AVE STE 250
CHICAGO IL
60640-5802
US

IV. Provider business mailing address

4411 N RAVENSWOOD AVE STE 250
CHICAGO IL
60640-5802
US

V. Phone/Fax

Practice location:
  • Phone: 708-406-9692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.102786
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: