MEDICARE: MS. ASHLEY LYNN LAJINESS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1134418742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASHLEY LYNN LAJINESS

Provider Business Mailing Address
First Line	:	2828 N PINE GROVE AVE
Second Line	:	APT. 411
City	:	CHICAGO
State	:	IL
Zip	:	60657-6188
Country	:	US
Telephone Number	:	734-693-3498
Fax Number	:

Provider Business Practice Location Address
First Line	:	2828 N PINE GROVE AVE
Second Line	:	APT. 411
City	:	CHICAGO
State	:	IL
Zip	:	60657-6188
Country	:	US
Telephone Number	:	734-693-3498
Fax Number	:

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/24/2011

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