Provider Demographics
NPI:1073927273
Name:KOEHLER, LAURA DAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:DAWN
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 N MILWAUKEE AVE # 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-9225
Mailing Address - Country:US
Mailing Address - Phone:312-476-9064
Mailing Address - Fax:630-839-8697
Practice Address - Street 1:1448 N MILWAUKEE AVE # 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-9225
Practice Address - Country:US
Practice Address - Phone:312-476-9064
Practice Address - Fax:630-839-8697
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008192103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical