Provider Demographics
NPI:1295987782
Name:PITASCH, LAUREN (LAC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PITASCH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 E. OLIVE ST.
Mailing Address - Street 2:2I
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004
Mailing Address - Country:US
Mailing Address - Phone:847-255-3884
Mailing Address - Fax:
Practice Address - Street 1:2403 E OLIVE ST
Practice Address - Street 2:2I
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5117
Practice Address - Country:US
Practice Address - Phone:847-255-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000683171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist