Provider Demographics
NPI:1104231471
Name:RAINE, LAURA SAUERBERG (MED)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SAUERBERG
Last Name:RAINE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-8116
Mailing Address - Country:US
Mailing Address - Phone:630-220-7367
Mailing Address - Fax:
Practice Address - Street 1:5757 S MADISON ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8116
Practice Address - Country:US
Practice Address - Phone:630-220-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional