Provider Demographics
NPI:1508394107
Name:ROMAN, LAURA (LCPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:REIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:100 N WAUKEGAN RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1660
Mailing Address - Country:US
Mailing Address - Phone:224-424-0185
Mailing Address - Fax:
Practice Address - Street 1:34121 N US HIGHWAY 45 STE 221
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1774
Practice Address - Country:US
Practice Address - Phone:224-424-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health