Provider Demographics
NPI:1861755951
Name:WRZESINSKI, LAURA RENEE (LMFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:RENEE
Last Name:WRZESINSKI
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 1:5131 N LINCOLN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2584
Mailing Address - Country:US
Mailing Address - Phone:971-930-0089
Mailing Address - Fax:
Practice Address - Street 1:5131 N LINCOLN AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2584
Practice Address - Country:US
Practice Address - Phone:971-930-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1159106H00000X
IL166.000996106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist