Active NPI
Amy E Lefstad
- Recreation Therapist
- North Chicago, IL
National Provider Identifier
1649008665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 53962
- Practice address
- 3001 Green Bay Rd
North Chicago, IL 60064-3048 - Phone
- (224) 610-5885
- NPI assigned
- Jul 22, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 53962 | WI | Primary |
Addresses
Primary practice location
3001 Green Bay Rd
North Chicago, IL 60064-3048
Mailing address
7817 22ND Ave
Kenosha, WI 53143-5720
Phone (602) 812-1770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53962 | WI | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721606400000",
"number": "1649008665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7817 22ND AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531435720",
"telephone_number": "602-812-1770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 GREEN BAY RD",
"city": "NORTH CHICAGO",
"state": "IL",
"postal_code": "600643048",
"telephone_number": "224-610-5885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEFSTAD",
"first_name": "AMY",
"middle_name": "E",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-22",
"last_updated": "2024-07-22",
"certification_date": "2024-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "WI",
"license": "53962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.