Healthcare Provider Details

I. General information

NPI: 1952221590
Provider Name (Legal Business Name): LAUREN FLETCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E HURON ST STE 803
CHICAGO IL
60611-2912
US

IV. Provider business mailing address

3509 N RACINE AVE GDN
CHICAGO IL
60657-1524
US

V. Phone/Fax

Practice location:
  • Phone: 312-640-2473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14450
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.040538
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: