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General NPI Number Information
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NPI Number | 1760157416
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Entity Type | Individual
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Provider Name | KELSEY LANHAM MAT
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Gender | Female
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Dates
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Enumeration Date | 08/14/2021
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 4733 N TALMAN AVE FL 1
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City | CHICAGO
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State | IL
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Zip | 60625-2993
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Country | US
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Telephone | 574-222-1194
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Fax |
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Provider Business Mailing Address
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Address Line | 4733 N TALMAN AVE FL 1
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City | CHICAGO
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State | IL
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Zip | 60625-2993
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Country | US
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Telephone | 574-220-1194
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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