MEDICARE: DR. ANNETTE LACEY PSY.D.

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	103TC0700X	Clinical Psychologist	071007134	IL

General Provider Information

NPI Number	:	1780725572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNETTE LACEY PSY.D.

Provider Business Mailing Address
First Line	:	825 E GOLF RD
Second Line	:	SUITE 1127
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5700
Country	:	US
Telephone Number	:	847-981-9200
Fax Number	:	847-981-9322

Provider Business Practice Location Address
First Line	:	825 E GOLF RD
Second Line	:	SUITE 1127
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5700
Country	:	US
Telephone Number	:	847-981-9200
Fax Number	:	847-981-9322

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	03/23/2009

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