Provider Demographics
NPI:1720657166
Name:LESSIG, ERICA PHYLIS
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:PHYLIS
Last Name:LESSIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:PHYLIS
Other - Last Name:LINDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:902 BRISTOL DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4843
Mailing Address - Country:US
Mailing Address - Phone:847-767-1179
Mailing Address - Fax:
Practice Address - Street 1:902 BRISTOL DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4843
Practice Address - Country:US
Practice Address - Phone:847-767-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist