Provider Demographics
NPI:1619433471
Name:LOWE, LASHAUNA MILLETTE
Entity type:Individual
Prefix:
First Name:LASHAUNA
Middle Name:MILLETTE
Last Name:LOWE
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 1:754 BLUFF ST APT 101
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1675
Mailing Address - Country:US
Mailing Address - Phone:630-427-5483
Mailing Address - Fax:
Practice Address - Street 1:754 BLUFF ST APT 101
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1675
Practice Address - Country:US
Practice Address - Phone:630-427-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician