Healthcare Provider Details

I. General information

NPI: 1710140678
Provider Name (Legal Business Name): CRAIG STEVEN LAASCH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N DIVISION ST SUITE 604
MORRIS IL
60450-1182
US

IV. Provider business mailing address

2469 E 2350TH RD
MARSEILLES IL
61341-9710
US

V. Phone/Fax

Practice location:
  • Phone: 815-941-3882
  • Fax: 815-941-3884
Mailing address:
  • Phone: 815-263-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number12778678
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: