Provider Demographics
NPI:1942489711
Name:KOERNER, LAURA M (LCPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:KOERNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HAWTHORN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1603
Mailing Address - Country:US
Mailing Address - Phone:847-302-1004
Mailing Address - Fax:
Practice Address - Street 1:85 REVERE DR
Practice Address - Street 2:AA
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-8001
Practice Address - Country:US
Practice Address - Phone:847-564-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.004603101YP2500X
IL180007408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional