Provider Demographics
NPI:1871964072
Name:KELLY, LAURIE K (LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:K
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:SCHARF
Other - Last Name:KASSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6020 OAKWOOD DR
Mailing Address - Street 2:UNIT 4D
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3088
Mailing Address - Country:US
Mailing Address - Phone:630-730-2269
Mailing Address - Fax:
Practice Address - Street 1:6020 OAKWOOD DR
Practice Address - Street 2:UNIT 4D
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3088
Practice Address - Country:US
Practice Address - Phone:630-730-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0123581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical