Provider Demographics
NPI:1023204351
Name:LANE, FRANK JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JOHN
Last Name:LANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 W RASCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1205
Mailing Address - Country:US
Mailing Address - Phone:773-250-4983
Mailing Address - Fax:312-567-3493
Practice Address - Street 1:5235 N CLARK ST
Practice Address - Street 2:SUITE 2 NORTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2122
Practice Address - Country:US
Practice Address - Phone:773-250-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional