Provider Demographics
NPI:1508508490
Name:AARON, LAKETA
Entity Type:Individual
Prefix:
First Name:LAKETA
Middle Name:
Last Name:AARON
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 1:4006 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60104-2014
Mailing Address - Country:US
Mailing Address - Phone:312-970-1081
Mailing Address - Fax:
Practice Address - Street 1:4006 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-2014
Practice Address - Country:US
Practice Address - Phone:312-970-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist