Healthcare Provider Details

I. General information

NPI: 1205771201
Provider Name (Legal Business Name): LASHERRY AVERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 S SACRAMENTO AVE APT 1W
CHICAGO IL
60629-2640
US

IV. Provider business mailing address

6150 S SACRAMENTO AVE
CHICAGO IL
60629-2666
US

V. Phone/Fax

Practice location:
  • Phone: 322-437-7022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-410513
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: