Provider Demographics
NPI:1487788170
Name:WOLFE, LAURA JEAN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 W BOUGHTON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5700
Mailing Address - Country:US
Mailing Address - Phone:630-771-0144
Mailing Address - Fax:630-771-9520
Practice Address - Street 1:682 W BOUGHTON RD
Practice Address - Street 2:SUITE D
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5700
Practice Address - Country:US
Practice Address - Phone:630-771-0144
Practice Address - Fax:630-771-9520
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932036OtherBCBS PROVIDER NUMBER