Provider Demographics
NPI:1811053242
Name:WINDSOR, LORA D (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:D
Last Name:WINDSOR
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3317
Mailing Address - Country:US
Mailing Address - Phone:630-204-0447
Mailing Address - Fax:630-232-4110
Practice Address - Street 1:825 W STATE ST
Practice Address - Street 2:SUITE 103C
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2080
Practice Address - Country:US
Practice Address - Phone:630-204-0447
Practice Address - Fax:630-232-4110
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22413101YA0400X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213225Medicare PIN