Provider Demographics
NPI:1558904342
Name:SPAKAUSKY, LAUREN ANN (RBT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:SPAKAUSKY
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1566
Mailing Address - Country:US
Mailing Address - Phone:984-384-7306
Mailing Address - Fax:
Practice Address - Street 1:14711 S RAVINIA AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3100
Practice Address - Country:US
Practice Address - Phone:708-787-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
ILRBT-20-123699106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician