Provider Demographics
NPI:1396392502
Name:STRADER, LAURA KATHRYN (LMFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHRYN
Last Name:STRADER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 W BELMONT AVE # 1091
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6471
Mailing Address - Country:US
Mailing Address - Phone:312-772-6648
Mailing Address - Fax:
Practice Address - Street 1:2155 W BELMONT AVE # 1091
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6471
Practice Address - Country:US
Practice Address - Phone:312-772-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL106.001876106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program