Individual
JAWAN LASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 S. MICHIGAN AVE, LLD, CHICAGO, IL 60616
(773) 354-0415
Mailing address
3753 S COTTAGE GROVE AVE, CHICAGO, IL 60653-1662
(312) 479-3038
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
277002699
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
277002699
IL
Other
Enumeration date
10/19/2021
Last updated
05/29/2025
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