Provider Demographics
NPI:1689419863
Name:FESTER, LAURIE (LPC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:FESTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:SIEVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 AUTUMNWOLF DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS JUNCTION
Mailing Address - State:IL
Mailing Address - Zip Code:61020-9430
Mailing Address - Country:US
Mailing Address - Phone:815-871-5191
Mailing Address - Fax:
Practice Address - Street 1:695 N PERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6225
Practice Address - Country:US
Practice Address - Phone:779-368-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional