Provider Demographics
NPI:1356329080
Name:GRIMES, LAURA L (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:L
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 N KELSO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4353
Mailing Address - Country:US
Mailing Address - Phone:773-659-9207
Mailing Address - Fax:
Practice Address - Street 1:840 W IRVING PARK RD STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3011
Practice Address - Country:US
Practice Address - Phone:773-659-9207
Practice Address - Fax:773-275-3880
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0094171041C0700X
IL1490094171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical