Provider Demographics
NPI:1073838595
Name:AXTON, LAUREN ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ANNE
Last Name:AXTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:AXTON
Other - Last Name:BRERETON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:7323 N HONORE ST # 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7323 N HONORE ST # 1N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1501
Practice Address - Country:US
Practice Address - Phone:773-875-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008587103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical