Provider Demographics
NPI:1548263379
Name:SCHULTZ, LAURA T (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:T
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6483
Mailing Address - Country:US
Mailing Address - Phone:312-802-1956
Mailing Address - Fax:
Practice Address - Street 1:13 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6483
Practice Address - Country:US
Practice Address - Phone:312-802-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004309103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5230OtherPART B