Provider Demographics
NPI:1205587862
Name:DUDEK, LORA ANN (LPC)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:ANN
Last Name:DUDEK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 IVY LN APT 202
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-0477
Mailing Address - Country:US
Mailing Address - Phone:515-451-6654
Mailing Address - Fax:
Practice Address - Street 1:2618 MITCHELL DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1608
Practice Address - Country:US
Practice Address - Phone:331-254-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional