Provider Demographics
NPI:1003045477
Name:LAFRANCE, ANN M (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:M
Last Name:LAFRANCE
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 BROADWAY
Mailing Address - Street 2:SUITE F1
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8602
Mailing Address - Country:US
Mailing Address - Phone:219-736-1000
Mailing Address - Fax:219-736-9699
Practice Address - Street 1:8300 BROADWAY
Practice Address - Street 2:SUITE F1
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8602
Practice Address - Country:US
Practice Address - Phone:219-736-1000
Practice Address - Fax:219-736-9699
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007565314000000X, 103TC0700X
IN20042454A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071007565OtherLICENSE
IN20042454AOtherINDIANA CLINICAL PSYCHOLOGY LICENSE