Provider Demographics
NPI:1295111920
Name:AVVA, LAKSHMI MOHANA
Entity type:Individual
Prefix:MRS
First Name:LAKSHMI
Middle Name:MOHANA
Last Name:AVVA
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 1:491 W WEATHERSFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-2849
Mailing Address - Country:US
Mailing Address - Phone:847-891-4825
Mailing Address - Fax:
Practice Address - Street 1:491 W WEATHERSFIELD WAY
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-2849
Practice Address - Country:US
Practice Address - Phone:847-891-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL217.000053222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist