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NPI Code Detail

MEDICARE: KRISTIN LACEY

MEDICARE: KRISTIN LACEY
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1750145991
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN LACEY
Provider Business Mailing Address
First Line : 618 CHESTERFIELD LN
Second Line :
City : SOUTH ELGIN
State : IL
Zip : 60177-3700
Country : US
Telephone Number : 847-207-5087
Fax Number :
Provider Business Practice Location Address
First Line : 618 CHESTERFIELD LN
Second Line :
City : SOUTH ELGIN
State : IL
Zip : 60177-3700
Country : US
Telephone Number : 847-207-5087
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2024
Last Update Date : 02/08/2024

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Directions to “ KRISTIN LACEY ” Practice Location

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