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General NPI Number Information
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NPI Number | 1568959187
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Entity Type | Organization
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Legal Business Name | LAURA ANDERSON, LLC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 2000 N RACINE AVE STE 2130
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City | CHICAGO
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State | IL
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Zip | 60614-4045
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Country | US
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Telephone | 402-289-8262
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 S ELMWOOD AVE
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City | OAK PARK
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State | IL
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Zip | 60304-2111
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Country | US
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Telephone | 402-289-8262
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Fax |
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Authorized Official
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Title or Position | OWNER AND LICENSED SOCIAL WORKER
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Name | LAURA HOLLINGSWORTH ANDERSON
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Credential | LCSW
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Telephone | 402-289-8262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 149015457
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License Number State | IL
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