Provider Demographics
NPI:1316602758
Name:GENSLINGER, LAURA (M EDS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GENSLINGER
Suffix:
Gender:F
Credentials:M EDS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:AGGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M EDS
Mailing Address - Street 1:10 MEAGAN LN
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4496
Mailing Address - Country:US
Mailing Address - Phone:708-903-9978
Mailing Address - Fax:
Practice Address - Street 1:10 MEAGAN LN
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4496
Practice Address - Country:US
Practice Address - Phone:708-903-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1883175103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool