Provider Demographics
NPI:1780999821
Name:STONE, LAURIE (LAC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E MAIN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-2149
Mailing Address - Country:US
Mailing Address - Phone:815-942-2580
Mailing Address - Fax:
Practice Address - Street 1:105 E MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-2149
Practice Address - Country:US
Practice Address - Phone:815-942-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000919171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist