Healthcare Provider Details

I. General information

NPI: 1659245371
Provider Name (Legal Business Name): JULIA CATE LAASCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2025
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 S MICHIGAN AVE
CHICAGO IL
60616-1209
US

IV. Provider business mailing address

2100 N LINCOLN PARK W APT 6EN
CHICAGO IL
60614-0928
US

V. Phone/Fax

Practice location:
  • Phone: 262-501-1162
  • Fax:
Mailing address:
  • Phone: 262-501-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011635
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: