Provider Demographics
NPI:1255476768
Name:GUENGERICH, LAURA M
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:GUENGERICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 MAPLE AVE
Mailing Address - Street 2:2
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4208
Mailing Address - Country:US
Mailing Address - Phone:224-392-6117
Mailing Address - Fax:
Practice Address - Street 1:1144 MAPLE AVE
Practice Address - Street 2:2
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-4208
Practice Address - Country:US
Practice Address - Phone:224-392-6117
Practice Address - Fax:224-392-6117
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.000450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist