Provider Demographics
NPI:1659502318
Name:DUFOUR, LAURA E (LSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:DUFOUR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 N HOWE ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6065
Mailing Address - Country:US
Mailing Address - Phone:312-305-7200
Mailing Address - Fax:312-943-2257
Practice Address - Street 1:1927 N HOWE ST
Practice Address - Street 2:APT. 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6065
Practice Address - Country:US
Practice Address - Phone:312-305-7200
Practice Address - Fax:312-943-2257
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150011637104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker