Provider Demographics
NPI:1790970689
Name:LOTT, STACY APRIL (MS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:APRIL
Last Name:LOTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 FOXWORTH BLVD APT 209
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4858
Mailing Address - Country:US
Mailing Address - Phone:773-895-1495
Mailing Address - Fax:
Practice Address - Street 1:3828 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4027
Practice Address - Country:US
Practice Address - Phone:773-826-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program