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NPI Code Detail

MEDICARE: MS. LARA LIESMA WOLFF LCPC

MEDICARE: MS. LARA LIESMA WOLFF LCPC
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
1101YP2500XProfessional Counselor180.012328IL

General Provider Information

NPI Number : 1568839314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LARA LIESMA WOLFF LCPC
Provider Business Mailing Address
First Line : 1746 W WINNEMAC AVE APT 2S
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2747
Country : US
Telephone Number : 773-954-9315
Fax Number :
Provider Business Practice Location Address
First Line : 1507 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4702
Country : US
Telephone Number : 773-569-1468
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2015
Last Update Date : 04/07/2021

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