Provider Demographics
NPI:1942675095
Name:STOGIN, LAURIE KATHLEEN
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:KATHLEEN
Last Name:STOGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:KATHLEEN
Other - Last Name:STOGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1105 LOCUST RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1240
Mailing Address - Country:US
Mailing Address - Phone:847-951-6584
Mailing Address - Fax:
Practice Address - Street 1:1105 LOCUST RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1240
Practice Address - Country:US
Practice Address - Phone:847-951-6584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional