Provider Demographics
NPI:1306010616
Name:FAZIO, LINDSAY TRAVELSTEAD (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:TRAVELSTEAD
Last Name:FAZIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 HARTREY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1056
Mailing Address - Country:US
Mailing Address - Phone:847-657-1820
Mailing Address - Fax:847-657-1825
Practice Address - Street 1:2050 PFINGSTEN RD STE 200
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026
Practice Address - Country:US
Practice Address - Phone:847-657-1820
Practice Address - Fax:847-657-1825
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007853103TC0700X
IN99035216A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical