| Doctor Name: | MR. RYAN S LAUTERWASSER |
| NPI Number: | 1154339992 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCPC |
| License Number: | 180-005201 |
| Business Practice Address: | 460 N Main St Suite 205 Glen Ellyn, IL - 601375176 |
| Business Phone Number: | 6307234145 |
| Business Fax Number: | |
| Mailing Address: | 111 N Union St, AURORA |
| State: | IL |
| Postal Code: | 605053537 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/04/2006 |
| NPI Last Update Date: | 01/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180-005201 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |