Provider Demographics
NPI:1366647380
Name:NEWLIN, LACIE NICOLE
Entity Type:Individual
Prefix:MISS
First Name:LACIE
Middle Name:NICOLE
Last Name:NEWLIN
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 1:420 W WRIGHTWOOD AVE
Mailing Address - Street 2:APT. 220
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4959
Mailing Address - Country:US
Mailing Address - Phone:765-366-5848
Mailing Address - Fax:
Practice Address - Street 1:420 W WRIGHTWOOD AVE
Practice Address - Street 2:APT. 220
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4959
Practice Address - Country:US
Practice Address - Phone:765-366-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist