Provider Demographics
NPI:1629359302
Name:LAKE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LAKE COUNTY HEALTH DEPARTMENT
Other - Org Name:LCHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PFISTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:262-497-0799
Mailing Address - Street 1:3010 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2321
Mailing Address - Country:US
Mailing Address - Phone:847-377-8974
Mailing Address - Fax:847-377-8803
Practice Address - Street 1:3010 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2321
Practice Address - Country:US
Practice Address - Phone:847-377-8974
Practice Address - Fax:847-377-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007494251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health