1205956380 NPI number — MS. KATHLEEN A. LAJEUNESSE L.C.P.C.

Table of content: MS. KATHLEEN A. LAJEUNESSE L.C.P.C. (NPI 1205956380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205956380 NPI number — MS. KATHLEEN A. LAJEUNESSE L.C.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAJEUNESSE
Provider First Name:
KATHLEEN
Provider Middle Name:
A.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAJEUNESSE
Provider Other First Name:
KAY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.P.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205956380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 LEEDS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60565-2448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-983-5025
Provider Business Mailing Address Fax Number:
630-653-1010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 E 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 265
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-3177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-527-1778
Provider Business Practice Location Address Fax Number:
630-653-1010
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02233105 . This is a "BLUE CROSS BLUE SHIELS IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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