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NPI Code Detail

MEDICARE: LAUREN N GOODE LMT

MEDICARE: LAUREN N GOODE LMT
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
1225700000XMassage Therapist227.010272IL

General Provider Information

NPI Number : 1174910400
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN N GOODE LMT
Provider Business Mailing Address
First Line : 922 W DIVERSEY PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1416
Country : US
Telephone Number : 773-529-0057
Fax Number :
Provider Business Practice Location Address
First Line : 922 W DIVERSEY PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1416
Country : US
Telephone Number : 773-529-0057
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2015
Last Update Date : 04/24/2015

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Directions to “ LAUREN N GOODE LMT” Practice Location

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