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Individual
JOANNA KATE LACKAYE
Active
Individual
JOANNA KATE LACKAYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
150012886
IL
1041C0700X
Clinical Social Worker
Primary
149.015939
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616824
BLUE SHIELD
IL
Enumeration date
07/20/2011
Last updated
01/31/2019
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