Provider Demographics
NPI:1033637038
Name:BIESENKAMP, LORA LEA (LCPC)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:LEA
Last Name:BIESENKAMP
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W 22ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6449
Mailing Address - Country:US
Mailing Address - Phone:630-882-2899
Mailing Address - Fax:
Practice Address - Street 1:350 W 22ND ST STE 101
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6449
Practice Address - Country:US
Practice Address - Phone:630-882-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty