Provider Demographics
NPI:1164197307
Name:GALLOWAY, LAQUIA
Entity Type:Individual
Prefix:
First Name:LAQUIA
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18241 WEST ST STE 206
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3282
Mailing Address - Country:US
Mailing Address - Phone:708-375-0670
Mailing Address - Fax:
Practice Address - Street 1:18241 WEST ST STE 206
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3282
Practice Address - Country:US
Practice Address - Phone:708-375-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health