Provider Demographics
NPI:1518587872
Name:LINDELL, LAURA KATHLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KATHLEEN
Last Name:LINDELL
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 1:6723 WEAVER RD STE 111
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8021
Mailing Address - Country:US
Mailing Address - Phone:779-548-5058
Mailing Address - Fax:
Practice Address - Street 1:6723 WEAVER RD STE 111
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8021
Practice Address - Country:US
Practice Address - Phone:779-548-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490140571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty