Individual
CHRISTOPHER J LACIVITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5536 W HENDERSON ST, CHICAGO, IL 60641-4135
(815) 690-6533
Mailing address
PO BOX 86, WOODSTOCK, IL 60098-0086
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
14004552
IL
235Z00000X
Speech-Language Pathologist
Primary
146004552
IL
Other
Enumeration date
07/10/2008
Last updated
07/10/2008
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