Individual
LAKEISHA ANN LONGINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
103 HUNTINGWOOD RD, MATTESON, IL 60443-1134
(312) 498-4551
Mailing address
103 HUNTINGWOOD RD, MATTESON, IL 60443-1134
(312) 498-4551
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
—
—
Other
Enumeration date
12/06/2023
Last updated
12/06/2023
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