Provider Demographics
NPI:1568959187
Name:LAURA ANDERSON, LLC
Entity Type:Organization
Organization Name:LAURA ANDERSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LICENSED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:HOLLINGSWORTH
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:402-289-8262
Mailing Address - Street 1:1111 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2111
Mailing Address - Country:US
Mailing Address - Phone:402-289-8262
Mailing Address - Fax:
Practice Address - Street 1:2000 N RACINE AVE STE 2130
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4045
Practice Address - Country:US
Practice Address - Phone:402-289-8262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149015457261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health