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General NPI Number Information
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NPI Number | 1508394107
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Entity Type | Individual
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Provider Name | LAURA ROMAN LCPC
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Gender | Female
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 34121 N US HIGHWAY 45 STE 221
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1774
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Country | US
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Telephone | 224-424-0185
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N WAUKEGAN RD STE 204
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1660
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Country | US
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Telephone | 224-424-0185
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.013283
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License Number State | IL
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