MEDICARE: LASHERRY AVERY

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	106S00000X	Behavior Technician	RBT-25-410513	IL

General Provider Information

NPI Number	:	1205771201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHERRY AVERY

Provider Business Mailing Address
First Line	:	6150 S SACRAMENTO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6150 S SACRAMENTO AVE APT 1W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2640
Country	:	US
Telephone Number	:	322-437-7022
Fax Number	:

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

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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Directions to “ LASHERRY AVERY ” Practice Location

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