MEDICARE: DR. ANN M LAFRANCE PSY.D., HSPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	071007565	IL
2	103TC0700X	Clinical Psychologist	071007565	IL
3	103TC0700X	Clinical Psychologist	20042454A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	071007565	OTHER	IL	LICENSE
2	20042454A	OTHER	IN	INDIANA CLINICAL PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1003045477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN M LAFRANCE PSY.D., HSPP

Provider Business Mailing Address
First Line	:	8300 BROADWAY
Second Line	:	SUITE F1
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-8602
Country	:	US
Telephone Number	:	219-736-1000
Fax Number	:	219-736-9699

Provider Business Practice Location Address
First Line	:	8300 BROADWAY
Second Line	:	SUITE F1
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-8602
Country	:	US
Telephone Number	:	219-736-1000
Fax Number	:	219-736-9699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	05/16/2011

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Directions to “ DR. ANN M LAFRANCE PSY.D., HSPP” Practice Location

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