Provider Demographics
NPI:1780205377
Name:LACZYNSKI, PAYTON (ATC)
Entity Type:Individual
Prefix:MISS
First Name:PAYTON
Middle Name:
Last Name:LACZYNSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24518 LAKEWOODS LN
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-0676
Mailing Address - Country:US
Mailing Address - Phone:815-482-5562
Mailing Address - Fax:
Practice Address - Street 1:24518 LAKEWOODS LN
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-0676
Practice Address - Country:US
Practice Address - Phone:815-482-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960044482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer