MEDICARE: MICHELE J LAKEMEYER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.026815	IL

General Provider Information

NPI Number	:	1427711050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE J LAKEMEYER LCSW

Provider Business Mailing Address
First Line	:	825 CHICAGO AVE # 2A
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-2375
Country	:	US
Telephone Number	:	773-207-3838
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 CHICAGO AVE # 2A
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-2375
Country	:	US
Telephone Number	:	773-207-3838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2021
Last Update Date	:	03/20/2024

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