Provider Demographics
NPI:1851624936
Name:NEWELL, LAURA (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:NEWELL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SHERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAURA NEWELL
Mailing Address - Street 1:11 CHRISTINA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189
Mailing Address - Country:US
Mailing Address - Phone:630-886-8340
Mailing Address - Fax:
Practice Address - Street 1:11 CHRISTINA CIR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-3108
Practice Address - Country:US
Practice Address - Phone:630-886-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist