Provider Demographics
NPI:1588804504
Name:JOSS, LAUREL RAE (MA, ECED)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:RAE
Last Name:JOSS
Suffix:
Gender:F
Credentials:MA, ECED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10235 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1350
Mailing Address - Country:US
Mailing Address - Phone:708-508-8944
Mailing Address - Fax:
Practice Address - Street 1:10235 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1350
Practice Address - Country:US
Practice Address - Phone:708-508-8944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst