Provider Demographics
NPI:1417158650
Name:HALL, LAKESHA D (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:
First Name:LAKESHA
Middle Name:D
Last Name:HALL
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15611 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4207
Mailing Address - Country:US
Mailing Address - Phone:708-299-1416
Mailing Address - Fax:708-333-9339
Practice Address - Street 1:15611 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4207
Practice Address - Country:US
Practice Address - Phone:708-299-1416
Practice Address - Fax:708-333-9339
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist