Provider Demographics
NPI:1124434048
Name:MAXWELL, LAURA ANN
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11219 S SAWYER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2706
Mailing Address - Country:US
Mailing Address - Phone:773-253-9856
Mailing Address - Fax:773-253-9876
Practice Address - Street 1:11053 S MILLARD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3327
Practice Address - Country:US
Practice Address - Phone:773-253-9856
Practice Address - Fax:773-253-9876
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist