Healthcare Provider Details

I. General information

NPI: 1659824928
Provider Name (Legal Business Name): LAUREN CRISANTI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10730 W 143RD ST STE 37
ORLAND PARK IL
60462-1940
US

IV. Provider business mailing address

PO BOX 2257
CHESTERTON IN
46304-0357
US

V. Phone/Fax

Practice location:
  • Phone: 800-564-0863
  • Fax:
Mailing address:
  • Phone: 219-926-8320
  • Fax: 219-926-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071.009338
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.009338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: