Provider Demographics
NPI:1700015344
Name:SMITH, LAURA LEE (MSOM, LAC, BS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSOM, LAC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34991 N CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2465
Mailing Address - Country:US
Mailing Address - Phone:847-244-9473
Mailing Address - Fax:
Practice Address - Street 1:34991 N CEMETERY RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2465
Practice Address - Country:US
Practice Address - Phone:847-244-9473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-03
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000833171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist