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NPI Code Detail

MEDICARE: LAKYN JEREMIAH

MEDICARE: LAKYN JEREMIAH
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
1101YM0800XMental Health Counselor
2104100000XSocial Worker150118187IL

General Provider Information

NPI Number : 1811563364
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAKYN JEREMIAH
Provider Business Mailing Address
First Line : 325 ILLINOIS RT 2
Second Line :
City : DIXON
State : IL
Zip : 61021-9118
Country : US
Telephone Number : 815-284-6611
Fax Number :
Provider Business Practice Location Address
First Line : 325 ILLINOIS RT 2
Second Line :
City : DIXON
State : IL
Zip : 61021-9118
Country : US
Telephone Number : 815-284-6611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2021
Last Update Date : 01/05/2026

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Directions to “ LAKYN JEREMIAH ” Practice Location

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