Provider Demographics
NPI:1366450645
Name:ROSTON, LAURIE D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:D
Last Name:ROSTON
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 1:9512 LINCOLNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1116
Mailing Address - Country:US
Mailing Address - Phone:847-677-7661
Mailing Address - Fax:
Practice Address - Street 1:3545 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1058
Practice Address - Country:US
Practice Address - Phone:847-251-7350
Practice Address - Fax:847-853-2600
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-001171104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker