Provider Demographics
NPI:1285026823
Name:KAEHLER, LAURA BENNETT
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BENNETT
Last Name:KAEHLER
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 1:10 W CALENDAR AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2323
Mailing Address - Country:US
Mailing Address - Phone:708-790-0400
Mailing Address - Fax:
Practice Address - Street 1:10 W CALENDAR AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2323
Practice Address - Country:US
Practice Address - Phone:708-790-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0142581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical