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General NPI Number Information
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NPI Number | 1023825197
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Entity Type | Individual
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Provider Name | LAKEISHA BRANNON
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Gender | Female
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 235 E 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60628-2807
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Country | US
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Telephone | 773-371-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 15949 LECLAIRE AVE APT 2B
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City | OAK FOREST
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State | IL
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Zip | 60452-3986
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Country | US
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Telephone | 708-359-0155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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