Provider Demographics
NPI:1568685345
Name:LEVY, LAURA ROBIN (MS)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ROBIN
Last Name:LEVY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W ALDINE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7919
Mailing Address - Country:US
Mailing Address - Phone:312-504-1780
Mailing Address - Fax:
Practice Address - Street 1:2000 N RACINE AVE
Practice Address - Street 2:SUITE 2090
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4045
Practice Address - Country:US
Practice Address - Phone:773-871-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1460002265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001622435OtherBLUE CROSS BLUE SHIELD
IL0001622435OtherBLUE CROSS BLUE SHIELD