Healthcare Provider Details

I. General information

NPI: 1699698068
Provider Name (Legal Business Name): LAUREN MARIE ERAZMUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 N CLYBOURN AVE
CHICAGO IL
60614-4031
US

IV. Provider business mailing address

5528 THOMAS AVE S
MINNEAPOLIS MN
55410-2544
US

V. Phone/Fax

Practice location:
  • Phone: 773-580-5369
  • Fax:
Mailing address:
  • Phone: 773-580-5369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.003573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: