Healthcare Provider Details

I. General information

NPI: 1841764552
Provider Name (Legal Business Name): CAITLYN LILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 S FRANKFORT SQUARE RD STE D
FRANKFORT IL
60423-9386
US

IV. Provider business mailing address

14501 KILDARE AVE
MIDLOTHIAN IL
60445-2651
US

V. Phone/Fax

Practice location:
  • Phone: 815-469-1500
  • Fax:
Mailing address:
  • Phone: 708-691-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: