Provider Demographics
NPI:1649827239
Name:POTTHOFF, LAUREN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MARIE
Last Name:POTTHOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4454 N MANOR AVE
Mailing Address - Street 2:GARDEN APARTMENT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3811
Mailing Address - Country:US
Mailing Address - Phone:815-757-9513
Mailing Address - Fax:
Practice Address - Street 1:3633 W LAKE AVE STE 406
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5804
Practice Address - Country:US
Practice Address - Phone:312-248-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent