Healthcare Provider Details

I. General information

NPI: 1003045477
Provider Name (Legal Business Name): ANN M LAFRANCE PSY.D., HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 BROADWAY SUITE F1
MERRILLVILLE IN
46410-8602
US

IV. Provider business mailing address

8300 BROADWAY SUITE F1
MERRILLVILLE IN
46410-8602
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-1000
  • Fax: 219-736-9699
Mailing address:
  • Phone: 219-736-1000
  • Fax: 219-736-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number071007565
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007565
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042454A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: