MEDICARE: LAUREN IRIGOYEN PSYD

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	071010414	IL
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1932455409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN IRIGOYEN PSYD

Provider Business Mailing Address
First Line	:	64 ORLAND SQUARE DR STE 112
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-6543
Country	:	US
Telephone Number	:	630-522-3124
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 ORLAND SQUARE DR STE 112
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-6543
Country	:	US
Telephone Number	:	630-522-3124
Fax Number	:

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

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	04/20/2021

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