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General NPI Number Information
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NPI Number | 1831654938
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Entity Type | Organization
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Legal Business Name | LAURIE M HANSON LCSW, LLC
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 5756 N RIDGE AVE STE 9
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City | CHICAGO
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State | IL
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Zip | 60660-5332
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Country | US
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Telephone | 773-417-5976
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Fax |
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Provider Business Mailing Address
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Address Line | 3117 N PAULINA ST APT 3
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City | CHICAGO
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State | IL
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Zip | 60657-6780
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Country | US
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Telephone | 773-844-8456
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER/THERAPIST
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Name | LAURIE MARIA RADES
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Credential | LCSW
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Telephone | 774-417-5976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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