Healthcare Provider Details

I. General information

NPI: 1811877863
Provider Name (Legal Business Name): ANDJELA KATARINA LAZIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 LAKEVIEW PKWY
VERNON HILLS IL
60061-1857
US

IV. Provider business mailing address

601 W WASHINGTON AVE APT 3H
LAKE BLUFF IL
60044-1727
US

V. Phone/Fax

Practice location:
  • Phone: 877-468-4140
  • Fax:
Mailing address:
  • Phone: 224-715-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: