Provider Demographics
NPI:1063639664
Name:LACAYO, JULIA D (DT)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:D
Last Name:LACAYO
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4561
Mailing Address - Country:US
Mailing Address - Phone:630-204-2031
Mailing Address - Fax:
Practice Address - Street 1:1264 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4561
Practice Address - Country:US
Practice Address - Phone:630-204-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist