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General NPI Number Information
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NPI Number | 1205527546
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Entity Type | Organization
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Legal Business Name | LAKE BLUFF SCHOOL DISTRICT 65
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 350 W WASHINGTON AVE
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1818
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Country | US
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Telephone | 847-347-4983
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Fax |
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Provider Business Mailing Address
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Address Line | 350 W WASHINGTON AVE
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPECIAL EDUCATION COORDINATOR
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Name | TRACY ROEHRICK
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Credential |
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Telephone | 847-234-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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