Healthcare Provider Details

I. General information

NPI: 1790480481
Provider Name (Legal Business Name): LAURA ANNE CARTWRIGHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 E NORRIS DR
OTTAWA IL
61350-3681
US

IV. Provider business mailing address

8402 CAPTONS LN APT 204
DARIEN IL
60561-5444
US

V. Phone/Fax

Practice location:
  • Phone: 815-433-1010
  • Fax:
Mailing address:
  • Phone: 217-691-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149021691
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: