Provider Demographics
NPI:1215272752
Name:SIEGEL, LAURIE HEINTZ (LCPC, CADC, MISAII)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:HEINTZ
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:LCPC, CADC, MISAII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10217 S HOYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2030
Mailing Address - Country:US
Mailing Address - Phone:312-718-4064
Mailing Address - Fax:
Practice Address - Street 1:10736 SOUTH CICERO AVE.
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-424-0001
Practice Address - Fax:708-424-1394
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IL180.002392101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)