Provider Demographics
NPI:1891863270
Name:FORTINI, LAURA KATHLEEN (MS, LCPC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KATHLEEN
Last Name:FORTINI
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 S CHESTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3728
Mailing Address - Country:US
Mailing Address - Phone:630-430-4306
Mailing Address - Fax:
Practice Address - Street 1:401 E PROSPECT AVE STE 202
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3396
Practice Address - Country:US
Practice Address - Phone:630-430-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health