Provider Demographics
NPI:1104389725
Name:KEY, LAUREN (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KEY
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, NCSP
Mailing Address - Street 1:2061 BUNKER CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1893
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 N RAYNOR AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6065
Practice Address - Country:US
Practice Address - Phone:815-740-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1126873103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool