Most Relevant Information
Provider Data
| NPI Number: | 1003490673 |
| Provider Name: | LAURA GREEN LSW |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/10/2021 |
| Last Updated: | 04/04/2023 |
Provider Practice Location
201 W SPRINGFIELD AVE
CHAMPAIGN
IL
618206385
Practice Location Phone/Fax
| Phone: | 2176934918 |
| Fax: |
Provider Mailing Location
201 W SPRINGFIELD AVE
CHAMPAIGN
IL
618206385
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |