Individual
LACEY ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4040 N DIVISION ST, MORRIS, IL 60450-9357
(815) 416-1749
Mailing address
4040 N DIVISION ST, MORRIS, IL 60450-9357
(815) 416-1749
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1880939
IL
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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