MEDICARE: MS. LAURIE D. ROSTON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	149-001171	IL

General Provider Information

NPI Number	:	1366450645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE D. ROSTON LCSW

Provider Business Mailing Address
First Line	:	9512 LINCOLNWOOD DR
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60203-1116
Country	:	US
Telephone Number	:	847-677-7661
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 LAKE AVE
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-1058
Country	:	US
Telephone Number	:	847-251-7350
Fax Number	:	847-853-2600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	08/02/2011

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