MEDICARE: DR. LAURA E LAMBERT PH.D.

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	103TC0700X	Clinical Psychologist	071.007179	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0009677974	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1053514364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA E LAMBERT PH.D.

Provider Business Mailing Address
First Line	:	5490 S SOUTH SHORE DRIVE 4N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5981
Country	:	US
Telephone Number	:	773-667-1063
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 S MICHIGAN AVE STE 1468
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-6155
Country	:	US
Telephone Number	:	773-642-5006
Fax Number	:

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/15/2021

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