Provider Demographics
NPI:1598157505
Name:TURNAGE, LAQUETTA
Entity Type:Individual
Prefix:
First Name:LAQUETTA
Middle Name:
Last Name:TURNAGE
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 1:1226 S KOLIN AVE
Mailing Address - Street 2:1ST FL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-1145
Mailing Address - Country:US
Mailing Address - Phone:773-447-8501
Mailing Address - Fax:
Practice Address - Street 1:1226 S KOLIN AVE
Practice Address - Street 2:1ST FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-1145
Practice Address - Country:US
Practice Address - Phone:773-447-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst