Provider Demographics
NPI:1720485436
Name:LAVALLEE, PATRICIA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:LAVALLEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2609
Mailing Address - Country:US
Mailing Address - Phone:847-251-1281
Mailing Address - Fax:
Practice Address - Street 1:1017 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2609
Practice Address - Country:US
Practice Address - Phone:847-251-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.003826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical