Provider Demographics
NPI:1225402449
Name:FIELDMAN, LAURIE B
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:B
Last Name:FIELDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:B
Other - Last Name:FIELDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1025 POTOMAC CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7921
Mailing Address - Country:US
Mailing Address - Phone:847-274-6582
Mailing Address - Fax:
Practice Address - Street 1:550 W SPERRY ST
Practice Address - Street 2:
Practice Address - City:HEPPNER
Practice Address - State:OR
Practice Address - Zip Code:97836
Practice Address - Country:US
Practice Address - Phone:541-676-9161
Practice Address - Fax:541-676-5662
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490067691041C0700X
ORL120541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical