Provider Demographics
NPI:1659784528
Name:SIMMONS, LAUREN IVY (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:IVY
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14858 SHEPARD DR
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-2467
Mailing Address - Country:US
Mailing Address - Phone:773-664-2811
Mailing Address - Fax:
Practice Address - Street 1:7410 S YATES BLVD # A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3316
Practice Address - Country:US
Practice Address - Phone:773-664-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-08
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041406961163W00000X, 163WP0808X
IL209029664363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health