Provider Demographics
NPI:1598004251
Name:CAIN, LAURA ANN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:CAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11133 S KEDZIE AVE
Mailing Address - Street 2:304
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2337
Mailing Address - Country:US
Mailing Address - Phone:773-812-5052
Mailing Address - Fax:
Practice Address - Street 1:11133 S KEDZIE AVE
Practice Address - Street 2:304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2337
Practice Address - Country:US
Practice Address - Phone:773-812-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist